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CPT code 40808: Mouth biopsy, oral vestibule2026 Medicare rate & RVUs in Delaware

Reports tissue sampling of a lesion in the oral vestibule, the space between the lips or cheeks and the teeth and gums, for diagnosis.

CMS RVU26DEffective Oct 1, 2026One payment locality8.5K Medicare services in 2024

In Delaware, Medicare pays $166.15 for 40808 in the office and $81.67 when it’s performed in a hospital or facility.

$166.15Office (non-facility)
$81.67Hospital or facility
−1.1%vs the national office rate ($168.01)

Check a contract rate as a % of Medicare · 40808 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 40808 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Delaware
  2. What 40808 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 40808 covers

This service samples a lesion in the oral vestibule—the lining inside the lips or cheeks, between them and the teeth and gums. A dentist, oral surgeon, or otolaryngologist may perform it in an office or outpatient setting when a persistent ulcer, abnormal patch, or other lesion needs tissue diagnosis. The specimen is sent for pathologic examination; the code represents the biopsy procedure, not the laboratory’s tissue analysis.

Report 40808 when tissue is sampled from the vestibule rather than when the lesion is removed by excision or lies at a different oral site. Document the lesion’s location and appearance, the tissue obtained, and the procedure performed. CMS assigns a 10-day global period, so related postoperative visits during that period are included. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard 50% reduction. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery for it, and co-surgeons and team surgery are not permitted.

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 Delaware compares for 40808

Across 109 of 109 payment localities, the office rate for 40808 runs from $147.51 in Arkansas to $226.72 in San Benito County, CA. Delaware pays $166.15. The RVUs are the same everywhere; the geographic indexes change the dollars.

40808 in Delaware vs other payment areas
  1. Delaware · this page$166.15
  2. Los Angeles, CA · California$191.49+$25.34
  3. Washington, DC area · District of Columbia$193.38+$27.23
  4. Miami, FL · Florida$180.46+$14.31
  5. Chicago, IL · Illinois$174.95+$8.80
  6. Manhattan, NY · New York$193.87+$27.72
  7. Alaska · Alaska$191.34+$25.19

Other areas in Delaware first, then benchmark localities. Bars start at $0.

Every other payment area

40808 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$149.82$75.00
ArkansasArkansas$147.51$74.06
ArizonaArizona$163.33$80.47
Bakersfield, CACalifornia$179.23$85.52
Chico, CACalifornia$178.83$85.11
El Centro, CACalifornia$178.85$85.13
Fresno, CACalifornia$178.83$85.11
Hanford, CACalifornia$178.83$85.11

40808 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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.

$147.51

$202.78

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
40808 office rate range by state
State / territoryOffice rate rangeLocalities
AK$191.341
AL$149.821
AR$147.511
AZ$163.331
CA$178.83–$226.7229
CO$175.661
CT$179.621
DC$193.381
DE$166.151
FL$164.67–$180.463
GA$154.94–$171.122
GU$183.751
HI$183.751
IA$154.201
ID$155.201
IL$159.39–$175.354
IN$156.171
KS$153.281
KY$153.261
LA$152.95–$161.022
MA$174.45–$193.972
MD$169.51–$193.383
ME$155.90–$165.122
MI$157.36–$166.692
MN$168.461
MO$150.05–$161.813
MS$148.821
MT$168.001
NC$157.661
ND$165.231
NE$155.141
NH$172.721
NJ$181.71–$191.152
NM$158.221
NV$167.351
NY$160.15–$198.625
OH$156.801
OK$153.131
OR$166.10–$181.702
PA$157.15–$174.822
PR$169.361
RI$172.411
SC$157.481
SD$164.901
TN$154.081
TX$156.04–$175.048
UT$159.771
VA$164.43–$193.382
VI$169.361
VT$164.401
WA$174.18–$198.202
WI$159.341
WV$153.091
WY$166.791

See 40808 in every payment locality

How the 40808 rate is calculated

Each of 40808’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 · 40808

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.02

1.02 RVUs× 1.000 GPCI

Practice expense3.87

3.87 RVUs× 1.000 GPCI

Malpractice0.14

0.14 RVUs× 1.000 GPCI

Adjusted RVUs

5.0300

Conversion factor

$33.4009

Medicare rate

$168.01

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Delaware inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

4,862

Code
40808
Physician work
1.02
Practice expense
3.87
Malpractice
0.14

GPCI2026.csv

40

Locality
Delaware
Physician work
1.005
Practice expense
0.988
Malpractice
0.899
Office calculation for 40808 in Delaware
ComponentRVULocality factorAdjusted
Physician work1.02× 1.0051.0251
Practice expense3.87× 0.9883.8236
Malpractice0.14× 0.8990.1259
Total RVUs4.9745
Conversion factor× 33.4009

Office rate, Delaware$166.15

Office: (1.02 × 1.005 + 3.87 × 0.988 + 0.14 × 0.899) × $33.4009 = $166.15

Facility: (1.02 × 1.005 + 1.31 × 0.988 + 0.14 × 0.899) × $33.4009 = $81.67

Open 40808 in the RVU calculator

Payment rules and modifiers for 40808

40808 has a 10-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 40808

Mouth biopsy, oral vestibule

RuleCMS valueWhat it means
Global period010Minor procedure: the day of the procedure plus 10 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.80/0.10Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 40808

Mouth biopsy, oral vestibule

10-day global period ends

Oct 11, 2026

Covers Oct 1, 2026 through Oct 11, 2026 (11 days).

Visit on Oct 31, 2026

After the global period ends: visits and procedures are billed normally.

SurgeryVisit
Sep 28, 2026Oct 14, 2026

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

40808 without 51 · national office

$168.01

Mouth biopsy, oral vestibule

40808-51 · Second procedure: 50%

$84.01

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%).

When to use modifier 51

Codes related to 40808

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 40808
CodeHow it relatesOffice range, Delaware
Used instead
40810Mouth lesion excision, without repairUsed when a vestibular lesion is excised instead of sampled for biopsy.$213.73
40490Lip biopsy, lip tissueBiopsy option for a lesion located on the lip.$119.12
41100Tongue biopsy, anterior two-thirdsBiopsy option for a lesion located on the tongue.$186.01
Often billed with
88305Tissue pathology exam, level IV specimenMay represent pathologic examination of the tissue specimen by the laboratory or pathologist.$69.66

How 40808 has changed in Delaware

40808 · Office / nonfacility

$166.15

Effective 2026-10-01

The base rate is $3.71 higher than on 2025-10-01, moving from $162.44 to $166.15 (2.3%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

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

  1. January 1, 2026

    RVU26A

    $162.44changed to$166.15

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.05 changed to 1.02
    • Malpractice RVU 0.13 changed to 0.14
    • Work GPCI 1.009 changed to 1.005
    • Practice expense GPCI 0.992 changed to 0.988
    • Malpractice GPCI 0.949 changed to 0.899

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $168.82changed to$162.44

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 3.92 changed to 3.87

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $166.06changed to$168.82

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $173.75changed to$166.06

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 3.93 changed to 3.92
    • Malpractice RVU 0.12 changed to 0.13
    • Work GPCI 1.007 changed to 1.009
    • Practice expense GPCI 1.007 changed to 0.992
    • Malpractice GPCI 0.938 changed to 0.949

  5. January 1, 2023

    RVU23A

    $177.63changed to$173.75

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 3.89 changed to 3.93
    • Malpractice RVU 0.11 changed to 0.12
    • Work GPCI 1.005 changed to 1.007
    • Practice expense GPCI 1.022 changed to 1.007
    • Malpractice GPCI 0.927 changed to 0.938

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $176.89changed to$177.63

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 3.81 changed to 3.89
    • Malpractice RVU 0.13 changed to 0.11

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $166.73changed to$176.89

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 3.38 changed to 3.81
    • Malpractice RVU 0.11 changed to 0.13
    • Work GPCI 1.006 changed to 1.005
    • Practice expense GPCI 1.021 changed to 1.022
    • Malpractice GPCI 1.023 changed to 0.927

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $197.35changed to$166.73

    • Conversion factor 36.0391 changed to 36.0896
    • Work RVU 1.01 changed to 1.05
    • Practice expense RVU 4.20 changed to 3.38
    • Malpractice RVU 0.16 changed to 0.11
    • Work GPCI 1.007 changed to 1.006
    • Practice expense GPCI 1.019 changed to 1.021
    • Malpractice GPCI 1.119 changed to 1.023

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $196.40changed to$197.35

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 4.18 changed to 4.20

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $198.17changed to$196.40

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 4.22 changed to 4.18
    • Work GPCI 1.010 changed to 1.007
    • Practice expense GPCI 1.025 changed to 1.019
    • Malpractice GPCI 1.101 changed to 1.119

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $200.79changed to$198.17

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 4.28 changed to 4.22
    • Work GPCI 1.012 changed to 1.010
    • Practice expense GPCI 1.031 changed to 1.025
    • Malpractice GPCI 1.083 changed to 1.101

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $201.15changed to$200.79

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 4.27 changed to 4.28

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $200.15changed to$201.15

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $198.85changed to$200.15

    • Conversion factor 35.8228 changed to 35.7547
    • Malpractice RVU 0.11 changed to 0.16
    • Practice expense GPCI 1.038 changed to 1.031
    • Malpractice GPCI 0.878 changed to 1.083

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $205.17changed to$198.85

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 4.72 changed to 4.27
    • Malpractice RVU 0.12 changed to 0.11
    • Practice expense GPCI 1.044 changed to 1.038
    • Malpractice GPCI 0.672 changed to 0.878

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $205.17

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$166.15$81.67RVU26D
2026-07-01$166.15$81.67RVU26C
2026-04-01$166.15$81.67RVU26B
2026-01-01$166.15$81.67RVU26A
2025-10-01$162.44$88.00RVU25D
2025-07-01$162.44$88.00RVU25C
2025-04-01$162.44$88.00RVU25B
2025-01-01$162.44$88.00RVU25A
2024-10-01$168.82$89.24RVU24D
2024-07-01$168.82$89.24RVU24C
2024-04-01$168.82$89.24RVU24B
2024-03-09$168.82$89.24RVU24AR
2024-01-01$166.06$87.78RVU24A
2023-10-01$173.75$90.15RVU23D
2023-07-01$173.75$90.15RVU23C
2023-04-01$173.75$90.15RVU23B
2023-01-01$173.75$90.15RVU23A
2022-10-01$177.63$89.56RVU22D
2022-07-01$177.63$89.56RVU22C
2022-04-01$177.63$89.56RVU22B
2022-01-01$177.63$89.56RVU22A
2021-10-01$176.89$89.52RVU21D
2021-07-01$176.89$89.52RVU21C
2021-04-01$176.89$89.52RVU21B
2021-01-01$176.89$89.52RVU21A
2020-10-01$166.73$90.45RVU20D
2020-07-01$166.73$90.45RVU20C
2020-04-01$166.73$90.45RVU20B
2020-01-01$166.73$90.45RVU20A
2019-10-01$197.35$112.51RVU19D
2019-07-01$197.35$112.51RVU19C
2019-04-01$197.35$112.51RVU19B
2019-01-01$197.35$112.51RVU19A
2018-10-01$196.40$114.59RVU18D
2018-07-01$196.40$114.59RVU18C
2018-04-01$196.40$114.59RVU18B
2018-01-01$196.40$114.59RVU18AR1
2017-10-01$198.17$116.14RVU17D
2017-07-01$198.17$116.14RVU17C
2017-04-01$198.17$116.14RVU17B
2017-01-01$198.17$116.14RVU17A
2016-10-01$200.79$117.37RVU16D
2016-07-01$200.79$117.37RVU16C
2016-04-01$200.79$117.37RVU16B
2016-01-01$200.79$117.37RVU16A
2015-10-01$201.15$117.79RVU15D
2015-07-01$201.15$117.79RVU15C
2015-04-01$200.15$117.20RVU15B
2015-01-01$200.15$117.20RVU15A
2014-10-01$198.85$114.81RVU14D
2014-07-01$198.85$114.81RVU14C
2014-04-01$198.85$114.81RVU14B
2014-01-01$198.85$114.81RVU14A
2013-10-01$205.17$116.02RVU13D
2013-07-01$205.17$116.02RVU13C
2013-04-01$205.17$116.02RVU13B
2013-01-01$205.17$116.02RVU13AR

Price 40808 for an earlier date of service

Where the Delaware rate applies

Delaware is a Medicare payment area, not a city. Our Census mapping connects it to 79 cities and communities in Delaware. Some span more than one payment area; confirm with the service ZIP.

  • Arden
  • Ardencroft
  • Ardentown
  • Bear
  • Bellefonte
  • Bethany Beach
  • Bethel
  • Blades

Browse all communities in Delaware

40808 billing questions

How is 40808 different from 40810?

40808 is for tissue sampling of a vestibular lesion. Choose an excision code such as 40810 when the service removes the lesion rather than taking a biopsy sample.

Can the pathology examination be billed separately?

The biopsy code represents the clinician’s tissue-sampling procedure. The laboratory or pathologist may separately report the appropriate examination of the submitted specimen.

Should modifier 50 be appended for lesions on both sides?

No. CMS identifies bilateral adjustment as inappropriate for 40808; modifier 50 should not be used for this service.

Are related follow-up visits included?

Yes. The code has a 10-day global period, which includes related postoperative visits during that period.

Can an assistant surgeon or co-surgeon be reported?

Medicare does not pay an assistant at surgery for 40808. Co-surgeons and team surgery are not permitted for this code.

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
RVUs for 40808PPRRVU2026_Oct_nonQPP.csv, line 4,862 (RVU26D)
Geographic factors for DelawareGPCI2026.csv, line 40 (RVU26D)

Open CMS sourceHow we calculate rates

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