CPT code 40490: Lip biopsy, lip tissue2026 Medicare rate & RVUs in Montana
Reports a biopsy of lip tissue to obtain a specimen from a suspicious lip lesion for diagnostic examination.
In Montana, Medicare pays $120.24 for 40490 in the office and $56.11 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 40490 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
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.
How Montana compares for 40490
Across 109 of 109 payment localities, the office rate for 40490 runs from $107.51 in Arkansas to $156.56 in San Benito County, CA. Montana pays $120.24. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Montana · this page$120.24
- Los Angeles, CA · California$134.52+$14.28
- Washington, DC area · District of Columbia$136.46+$16.22
- Miami, FL · Florida$129.51+$9.27
- Chicago, IL · Illinois$126.09+$5.85
- Manhattan, NY · New York$137.53+$17.29
- Alaska · Alaska$143.29+$23.05
Other areas in Montana first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $108.94 | $52.83 |
| ArkansasArkansas | $107.51 | $52.43 |
| ArizonaArizona | $117.29 | $55.15 |
| Bakersfield, CACalifornia | $126.77 | $56.49 |
| Chico, CACalifornia | $126.40 | $56.12 |
| El Centro, CACalifornia | $126.42 | $56.14 |
| Fresno, CACalifornia | $126.40 | $56.12 |
| Hanford, CACalifornia | $126.40 | $56.12 |
| Madera, CACalifornia | $126.40 | $56.12 |
| Merced, CACalifornia | $126.40 | $56.12 |
| Modesto, CACalifornia | $126.40 | $56.12 |
| Napa, CACalifornia | $145.10 | $60.58 |
| Oxnard, CACalifornia | $133.77 | $57.96 |
| Redding, CACalifornia | $126.40 | $56.12 |
| Rest of CaliforniaCalifornia | $126.40 | $56.12 |
| Riverside, CACalifornia | $127.71 | $57.43 |
| Sacramento, CACalifornia | $132.28 | $57.70 |
| Salinas, CACalifornia | $131.78 | $57.45 |
| San Diego, CACalifornia | $134.59 | $57.89 |
| Marin County, CACalifornia | $153.21 | $62.79 |
| San Francisco, CACalifornia | $153.07 | $62.65 |
| San Benito County, CACalifornia | $156.56 | $64.09 |
| Santa Clara County, CACalifornia | $156.01 | $63.53 |
| San Luis Obispo, CACalifornia | $129.69 | $56.65 |
| Santa Cruz, CACalifornia | $135.66 | $57.75 |
| Santa Maria, CACalifornia | $132.19 | $57.42 |
| Santa Rosa, CACalifornia | $137.02 | $58.26 |
| Stockton, CACalifornia | $126.40 | $56.12 |
| Vallejo, CACalifornia | $144.90 | $60.38 |
| Visalia, CACalifornia | $126.40 | $56.12 |
| Yuba City, CACalifornia | $126.40 | $56.12 |
| ColoradoColorado | $124.74 | $56.50 |
| ConnecticutConnecticut | $127.77 | $58.70 |
| DelawareDelaware | $119.12 | $55.76 |
| Fort Lauderdale, FLFlorida | $124.48 | $59.51 |
| Rest of FloridaFlorida | $118.89 | $57.59 |
| Atlanta, GAGeorgia | $122.39 | $57.24 |
| Rest of GeorgiaGeorgia | $112.75 | $55.55 |
| Hawaii, Guam, HIHawaii | $129.03 | $56.12 |
| IowaIowa | $111.32 | $52.65 |
| IdahoIdaho | $112.01 | $53.01 |
| East St. Louis, ILIllinois | $118.19 | $59.19 |
| Rest of IllinoisIllinois | $115.85 | $57.29 |
| Suburban Chicago, ILIllinois | $125.68 | $59.82 |
| IndianaIndiana | $112.60 | $53.15 |
| KansasKansas | $110.91 | $52.94 |
| KentuckyKentucky | $111.41 | $54.40 |
| New Orleans, LALouisiana | $116.28 | $55.93 |
| Rest of LouisianaLouisiana | $111.28 | $54.52 |
| Metropolitan Boston, MAMassachusetts | $136.27 | $59.70 |
| Rest of MassachusettsMassachusetts | $124.12 | $56.59 |
| Baltimore area, MDMaryland | $127.41 | $58.60 |
| Rest of MarylandMaryland | $121.23 | $56.33 |
| Rest of MaineMaine | $112.61 | $53.61 |
| Southern Maine, MEMaine | $118.08 | $54.52 |
| Detroit, MIMichigan | $120.32 | $58.43 |
| Rest of MichiganMichigan | $114.11 | $55.56 |
| MinnesotaMinnesota | $119.64 | $53.65 |
| Metropolitan Kansas City, MOMissouri | $115.49 | $55.27 |
| Metropolitan St. Louis, MOMissouri | $116.58 | $55.53 |
| Rest of MissouriMissouri | $109.58 | $54.30 |
| MississippiMississippi | $108.57 | $53.35 |
| North CarolinaNorth Carolina | $113.67 | $53.84 |
| North DakotaNorth Dakota | $117.86 | $53.73 |
| NebraskaNebraska | $111.86 | $52.67 |
| New HampshireNew Hampshire | $122.88 | $56.12 |
| Northern New JerseyNew Jersey | $135.26 | $60.87 |
| Rest of New JerseyNew Jersey | $129.26 | $59.23 |
| New MexicoNew Mexico | $114.70 | $55.89 |
| NevadaNevada | $119.65 | $55.46 |
| NYC suburbs and Long Island, NYNew York | $140.68 | $64.43 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $130.14 | $59.92 |
| Queens, NYNew York | $138.48 | $62.68 |
| Rest of New YorkNew York | $115.23 | $54.31 |
| OhioOhio | $113.62 | $55.07 |
| OklahomaOklahoma | $111.17 | $53.90 |
| Portland, OROregon | $128.34 | $57.10 |
| Rest of OregonOregon | $118.75 | $54.87 |
| Metropolitan Philadelphia, PAPennsylvania | $124.87 | $58.11 |
| Rest of PennsylvaniaPennsylvania | $113.75 | $54.88 |
| Puerto RicoPuerto Rico | $121.02 | $56.19 |
| Rhode IslandRhode Island | $123.09 | $56.84 |
| South CarolinaSouth Carolina | $113.83 | $54.57 |
| South DakotaSouth Dakota | $117.58 | $53.45 |
| TennesseeTennessee | $111.43 | $53.13 |
| Austin, TXTexas | $124.30 | $56.45 |
| Beaumont, TXTexas | $113.07 | $54.72 |
| Brazoria, TXTexas | $118.99 | $55.44 |
| Dallas, TXTexas | $119.73 | $55.85 |
| Fort Worth, TXTexas | $119.01 | $55.78 |
| Galveston, TXTexas | $119.34 | $55.66 |
| Houston, TXTexas | $121.53 | $57.85 |
| Rest of TexasTexas | $115.95 | $55.09 |
| UtahUtah | $115.25 | $54.96 |
| VirginiaVirginia | $117.76 | $54.73 |
| Virgin Islands, VIUnited States Virgin Islands | $121.02 | $56.19 |
| VermontVermont | $117.50 | $54.01 |
| Rest of WashingtonWashington | $123.86 | $56.33 |
| King County, WAWashington | $138.86 | $60.17 |
| WisconsinWisconsin | $114.26 | $52.82 |
| West VirginiaWest Virginia | $111.95 | $56.22 |
| WyomingWyoming | $119.20 | $55.07 |
40490 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$107.51
$143.29
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $143.29 | 1 |
| AL | $108.94 | 1 |
| AR | $107.51 | 1 |
| AZ | $117.29 | 1 |
| CA | $126.40–$156.56 | 29 |
| CO | $124.74 | 1 |
| CT | $127.77 | 1 |
| DC | $136.46 | 1 |
| DE | $119.12 | 1 |
| FL | $118.89–$129.51 | 3 |
| GA | $112.75–$122.39 | 2 |
| GU | $129.03 | 1 |
| HI | $129.03 | 1 |
| IA | $111.32 | 1 |
| ID | $112.01 | 1 |
| IL | $115.85–$126.09 | 4 |
| IN | $112.60 | 1 |
| KS | $110.91 | 1 |
| KY | $111.41 | 1 |
| LA | $111.28–$116.28 | 2 |
| MA | $124.12–$136.27 | 2 |
| MD | $121.23–$136.46 | 3 |
| ME | $112.61–$118.08 | 2 |
| MI | $114.11–$120.32 | 2 |
| MN | $119.64 | 1 |
| MO | $109.58–$116.58 | 3 |
| MS | $108.57 | 1 |
| MT | $120.24 | 1 |
| NC | $113.67 | 1 |
| ND | $117.86 | 1 |
| NE | $111.86 | 1 |
| NH | $122.88 | 1 |
| NJ | $129.26–$135.26 | 2 |
| NM | $114.70 | 1 |
| NV | $119.65 | 1 |
| NY | $115.23–$140.68 | 5 |
| OH | $113.62 | 1 |
| OK | $111.17 | 1 |
| OR | $118.75–$128.34 | 2 |
| PA | $113.75–$124.87 | 2 |
| PR | $121.02 | 1 |
| RI | $123.09 | 1 |
| SC | $113.83 | 1 |
| SD | $117.58 | 1 |
| TN | $111.43 | 1 |
| TX | $113.07–$124.30 | 8 |
| UT | $115.25 | 1 |
| VA | $117.76–$136.46 | 2 |
| VI | $121.02 | 1 |
| VT | $117.50 | 1 |
| WA | $123.86–$138.86 | 2 |
| WI | $114.26 | 1 |
| WV | $111.95 | 1 |
| WY | $119.20 | 1 |
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.
The exact Montana inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
4,819
- Code
- 40490
- Physician work
- 1.19
- Practice expense
- 2.29
- Malpractice
- 0.12
GPCI2026.csv
71
- Locality
- Montana
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.998
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.19 | × 1.000 | 1.1900 |
| Practice expense | 2.29 | × 1.000 | 2.2900 |
| Malpractice | 0.12 | × 0.998 | 0.1198 |
| Total RVUs | 3.5998 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Montana$120.24
Office: (1.19 × 1 + 2.29 × 1 + 0.12 × 0.998) × $33.4009 = $120.24
Facility: (1.19 × 1 + 0.37 × 1 + 0.12 × 0.998) × $33.4009 = $56.11
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%).
How 40490 has changed in Montana
40490 · Office / nonfacility
$120.24
Effective 2026-10-01
The base rate is $1.94 higher than on 2025-10-01, moving from $118.30 to $120.24 (1.6%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2026
RVU26A
$118.30changed to$120.24
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 1.22 changed to 1.19
- Practice expense RVU 2.31 changed to 2.29
- Malpractice RVU 0.13 changed to 0.12
- Malpractice GPCI 0.978 changed to 0.998
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$122.40changed to$118.30
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 2.33 changed to 2.31
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$120.41changed to$122.40
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$124.62changed to$120.41
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 2.34 changed to 2.33
- Malpractice RVU 0.12 changed to 0.13
January 1, 2023
RVU23A
$126.23changed to$124.62
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 2.32 changed to 2.34
- Malpractice RVU 0.11 changed to 0.12
- Malpractice GPCI 0.977 changed to 0.978
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$128.65changed to$126.23
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 2.34 changed to 2.32
- Malpractice RVU 0.13 changed to 0.11
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$129.32changed to$128.65
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 2.22 changed to 2.34
- Malpractice RVU 0.11 changed to 0.13
- Malpractice GPCI 1.304 changed to 0.977
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$133.25changed to$129.32
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 2.20 changed to 2.22
- Malpractice RVU 0.17 changed to 0.11
- Malpractice GPCI 1.631 changed to 1.304
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$136.34changed to$133.25
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 2.29 changed to 2.20
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$135.05changed to$136.34
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 2.30 changed to 2.29
- Malpractice GPCI 1.429 changed to 1.631
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$133.14changed to$135.05
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 2.29 changed to 2.30
- Malpractice GPCI 1.226 changed to 1.429
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$133.53changed to$133.14
- Conversion factor 35.9335 changed to 35.8043
- Practice expense RVU 2.30 changed to 2.29
- Malpractice RVU 0.16 changed to 0.17
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$132.87changed to$133.53
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$130.68changed to$132.87
- Conversion factor 35.8228 changed to 35.7547
- Practice expense RVU 2.23 changed to 2.30
- Malpractice RVU 0.17 changed to 0.16
- Malpractice GPCI 1.165 changed to 1.226
Held through RVU15B.
January 1, 2014
RVU14A
$134.00changed to$130.68
- Conversion factor 34.0230 changed to 35.8228
- Practice expense RVU 2.52 changed to 2.23
- Malpractice RVU 0.18 changed to 0.17
- Malpractice GPCI 1.103 changed to 1.165
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $134.00
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $120.24 | $56.11 | RVU26D |
| 2026-07-01 | $120.24 | $56.11 | RVU26C |
| 2026-04-01 | $120.24 | $56.11 | RVU26B |
| 2026-01-01 | $120.24 | $56.11 | RVU26A |
| 2025-10-01 | $118.30 | $67.19 | RVU25D |
| 2025-07-01 | $118.30 | $67.19 | RVU25C |
| 2025-04-01 | $118.30 | $67.19 | RVU25B |
| 2025-01-01 | $118.30 | $67.19 | RVU25A |
| 2024-10-01 | $122.40 | $68.48 | RVU24D |
| 2024-07-01 | $122.40 | $68.48 | RVU24C |
| 2024-04-01 | $122.40 | $68.48 | RVU24B |
| 2024-03-09 | $122.40 | $68.48 | RVU24AR |
| 2024-01-01 | $120.41 | $67.36 | RVU24A |
| 2023-10-01 | $124.62 | $69.38 | RVU23D |
| 2023-07-01 | $124.62 | $69.38 | RVU23C |
| 2023-04-01 | $124.62 | $69.38 | RVU23B |
| 2023-01-01 | $124.62 | $69.38 | RVU23A |
| 2022-10-01 | $126.23 | $69.47 | RVU22D |
| 2022-07-01 | $126.23 | $69.47 | RVU22C |
| 2022-04-01 | $126.23 | $69.47 | RVU22B |
| 2022-01-01 | $126.23 | $69.47 | RVU22A |
| 2021-10-01 | $128.65 | $70.73 | RVU21D |
| 2021-07-01 | $128.65 | $70.73 | RVU21C |
| 2021-04-01 | $128.65 | $70.73 | RVU21B |
| 2021-01-01 | $128.65 | $70.73 | RVU21A |
| 2020-10-01 | $129.32 | $74.47 | RVU20D |
| 2020-07-01 | $129.32 | $74.47 | RVU20C |
| 2020-04-01 | $129.32 | $74.47 | RVU20B |
| 2020-01-01 | $129.32 | $74.47 | RVU20A |
| 2019-10-01 | $133.25 | $79.19 | RVU19D |
| 2019-07-01 | $133.25 | $79.19 | RVU19C |
| 2019-04-01 | $133.25 | $79.19 | RVU19B |
| 2019-01-01 | $133.25 | $79.19 | RVU19A |
| 2018-10-01 | $136.34 | $79.82 | RVU18D |
| 2018-07-01 | $136.34 | $79.82 | RVU18C |
| 2018-04-01 | $136.34 | $79.82 | RVU18B |
| 2018-01-01 | $136.34 | $79.82 | RVU18AR1 |
| 2017-10-01 | $135.05 | $79.06 | RVU17D |
| 2017-07-01 | $135.05 | $79.06 | RVU17C |
| 2017-04-01 | $135.05 | $79.06 | RVU17B |
| 2017-01-01 | $135.05 | $79.06 | RVU17A |
| 2016-10-01 | $133.14 | $77.28 | RVU16D |
| 2016-07-01 | $133.14 | $77.28 | RVU16C |
| 2016-04-01 | $133.14 | $77.28 | RVU16B |
| 2016-01-01 | $133.14 | $77.28 | RVU16A |
| 2015-10-01 | $133.53 | $77.12 | RVU15D |
| 2015-07-01 | $133.53 | $77.12 | RVU15C |
| 2015-04-01 | $132.87 | $76.74 | RVU15B |
| 2015-01-01 | $132.87 | $76.74 | RVU15A |
| 2014-10-01 | $130.68 | $76.59 | RVU14D |
| 2014-07-01 | $130.68 | $76.59 | RVU14C |
| 2014-04-01 | $130.68 | $76.59 | RVU14B |
| 2014-01-01 | $130.68 | $76.59 | RVU14A |
| 2013-10-01 | $134.00 | $75.14 | RVU13D |
| 2013-07-01 | $134.00 | $75.14 | RVU13C |
| 2013-04-01 | $134.00 | $75.14 | RVU13B |
| 2013-01-01 | $134.00 | $75.14 | RVU13AR |
Where the Montana rate applies
Montana is a Medicare payment area, not a city. Our Census mapping connects it to 497 cities and communities in Montana. Some span more than one payment area; confirm with the service ZIP.
- Absarokee
- Acton
- Alberton
- Alder
- Alzada
- Amsterdam
- Anaconda-Deer Lodge County
- Antelope
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
Show the CMS file lines behind this rate
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