CPT code 40490: Lip biopsy, lip tissue2026 Medicare rate & RVUs in Michigan
Reports a biopsy of lip tissue to obtain a specimen from a suspicious lip lesion for diagnostic examination.
Medicare pays $114.11–$120.32 for 40490 in the office in Michigan, from Rest of Michigan to Detroit, MI. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What 40490 covers
A clinician removes a tissue sample from a lip lesion for diagnostic evaluation. This service is commonly performed by dermatologists, otolaryngologists, oral surgeons, and other clinicians who evaluate lip abnormalities in an office or facility setting. The target must be on the lip; a lesion elsewhere in the mouth has a site-specific biopsy code. A biopsy obtains a diagnostic sample rather than removing a lesion as definitive treatment.
Select the code from the documented biopsy site and procedure, and retain the operative note describing the lip location, lesion, and tissue sampled. The specimen may be sent for separate pathology evaluation. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate for this code. CMS does not pay for an assistant at surgery, co-surgeons, or team surgery for this service.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 40490 pays more and less in Michigan
| Payment locality | Office | Facility |
|---|---|---|
| Detroit, MI | $120.32 | $58.43 |
| Rest of Michigan | $114.11 | $55.56 |
How the 40490 rate is calculated
Each of 40490’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 40490
RVUs × geographic indexes × conversion factor
Work1.19
1.19 RVUs× 1.000 GPCI
Practice expense2.29
2.29 RVUs× 1.000 GPCI
Malpractice0.12
0.12 RVUs× 1.000 GPCI
Adjusted RVUs
3.6000
Conversion factor
$33.4009
Medicare rate
$120.24
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 40490
The CMS indicators that decide how 40490 is paid alongside other services.
CMS payment indicators · 40490
Lip biopsy, lip tissue
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
40490 without 51 · national office
$120.24
Lip biopsy, lip tissue
40490-51 · Second procedure: 50%
$60.12
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
40490 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 40808Mouth biopsyOral vestibule
- 40490 is for lip tissue; 40808 is for a lesion in the vestibule of the mouth. Base selection on the documented biopsy site.
- 41100Tongue biopsyAnterior two-thirds
- Use 41100 when the sampled lesion is on the tongue. A lip lesion is reported with 40490.
- 11104Punch biopsySingle skin lesion
- 11104 describes a punch biopsy of a skin lesion. Consider it for a skin target outside the lip, rather than a biopsy of lip tissue.
40490 billing questions
How is 40490 distinguished from a biopsy elsewhere in the mouth?
Use 40490 when the sampled tissue is on the lip. Biopsies of the tongue, floor of mouth, palate, or oral vestibule have site-specific codes.
Is 40490 a biopsy or an excision?
It reports obtaining a diagnostic tissue sample from the lip. If the procedure removes a lesion rather than sampling it for diagnosis, evaluate the applicable excision code instead.
Can modifier 50 be used when both lips are sampled?
No. CMS bilateral adjustment does not apply to 40490, and modifier 50 is inappropriate for this descriptor and anatomy.
What same-day care is included?
The 0-day global period includes the related preoperative and postoperative care furnished on the procedure date.
How does CMS handle 40490 with another procedure in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction, with payment at 50%.
What documentation supports reporting 40490?
Document that the sampled lesion is on the lip, its location and clinical description, and the tissue obtained. Include the procedure details and specimen disposition.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
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