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

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 Queens, NY, Medicare pays $195.78 for 40808 in the office and $94.71 when it’s performed in a hospital or facility.

$195.78Office (non-facility)
$94.71Hospital or facility
+16.5%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 Queens, NY
  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 Queens, NY 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. Queens, NY pays $195.78. The RVUs are the same everywhere; the geographic indexes change the dollars.

40808 in Queens, NY vs other payment areas
  1. Queens, NY · this page$195.78
  2. Manhattan, NY · New York$193.87−$1.91
  3. NYC suburbs and Long Island, NY · New York$198.62+$2.84
  4. Poughkeepsie and northern NYC suburbs, NY · New York$182.80−$12.98
  5. Rest of New York · New York$160.15−$35.63
  6. Los Angeles, CA · California$191.49−$4.29
  7. Washington, DC area · District of Columbia$193.38−$2.40

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

Every other payment area

40808 in every other Medicare payment locality
Payment localityOfficeFacility
Miami, FLFlorida$180.46$91.44
Chicago, ILIllinois$174.95$89.01
AlaskaAlaska$191.34$100.28
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

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 Queens, NY 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

81

Locality
Queens, NY
Physician work
1.064
Practice expense
1.182
Malpractice
1.442
Office calculation for 40808 in Queens, NY
ComponentRVULocality factorAdjusted
Physician work1.02× 1.0641.0853
Practice expense3.87× 1.1824.5743
Malpractice0.14× 1.4420.2019
Total RVUs5.8615
Conversion factor× 33.4009

Office rate, Queens, NY$195.78

Office: (1.02 × 1.064 + 3.87 × 1.182 + 0.14 × 1.442) × $33.4009 = $195.78

Facility: (1.02 × 1.064 + 1.31 × 1.182 + 0.14 × 1.442) × $33.4009 = $94.71

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, Queens, NY
Used instead
40810Mouth lesion excision, without repairUsed when a vestibular lesion is excised instead of sampled for biopsy.$251.76
40490Lip biopsy, lip tissueBiopsy option for a lesion located on the lip.$138.48
41100Tongue biopsy, anterior two-thirdsBiopsy option for a lesion located on the tongue.$218.48
Often billed with
88305Tissue pathology exam, level IV specimenMay represent pathologic examination of the tissue specimen by the laboratory or pathologist.$80.20

How 40808 has changed in Queens, NY

40808 · Office / nonfacility

$195.78

Effective 2026-10-01

The base rate is $3.87 higher than on 2025-10-01, moving from $191.91 to $195.78 (2.0%).

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

    $191.91changed to$195.78

    • 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 1.065 changed to 1.064
    • Practice expense GPCI 1.195 changed to 1.182
    • Malpractice GPCI 1.462 changed to 1.442

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $199.48changed to$191.91

    • 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

    $196.23changed to$199.48

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $207.54changed to$196.23

    • 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 1.061 changed to 1.065
    • Practice expense GPCI 1.212 changed to 1.195
    • Malpractice GPCI 2.061 changed to 1.462

  5. January 1, 2023

    RVU23A

    $213.81changed to$207.54

    • 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 1.056 changed to 1.061
    • Practice expense GPCI 1.228 changed to 1.212
    • Malpractice GPCI 2.661 changed to 2.061

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $214.01changed to$213.81

    • 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

    $197.52changed to$214.01

    • 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 1.054 changed to 1.056
    • Practice expense GPCI 1.214 changed to 1.228
    • Malpractice GPCI 2.391 changed to 2.661

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $232.16changed to$197.52

    • 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 1.052 changed to 1.054
    • Practice expense GPCI 1.200 changed to 1.214
    • Malpractice GPCI 2.121 changed to 2.391

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $231.04changed to$232.16

    • 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

    $232.22changed to$231.04

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 4.22 changed to 4.18
    • Malpractice GPCI 2.151 changed to 2.121

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $234.27changed to$232.22

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 4.28 changed to 4.22
    • Practice expense GPCI 1.199 changed to 1.200
    • Malpractice GPCI 2.181 changed to 2.151

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $234.69changed to$234.27

    • 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

    $233.52changed to$234.69

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $228.58changed to$233.52

    • Conversion factor 35.8228 changed to 35.7547
    • Malpractice RVU 0.11 changed to 0.16
    • Work GPCI 1.057 changed to 1.052
    • Practice expense GPCI 1.197 changed to 1.199
    • Malpractice GPCI 1.836 changed to 2.181

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $234.48changed to$228.58

    • 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
    • Work GPCI 1.062 changed to 1.057
    • Practice expense GPCI 1.195 changed to 1.197
    • Malpractice GPCI 1.491 changed to 1.836

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $234.48

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$195.78$94.71RVU26D
2026-07-01$195.78$94.71RVU26C
2026-04-01$195.78$94.71RVU26B
2026-01-01$195.78$94.71RVU26A
2025-10-01$191.91$102.23RVU25D
2025-07-01$191.91$102.23RVU25C
2025-04-01$191.91$102.23RVU25B
2025-01-01$191.91$102.23RVU25A
2024-10-01$199.48$103.62RVU24D
2024-07-01$199.48$103.62RVU24C
2024-04-01$199.48$103.62RVU24B
2024-03-09$199.48$103.62RVU24AR
2024-01-01$196.23$101.92RVU24A
2023-10-01$207.54$106.92RVU23D
2023-07-01$207.54$106.92RVU23C
2023-04-01$207.54$106.92RVU23B
2023-01-01$207.54$106.92RVU23A
2022-10-01$213.81$108.00RVU22D
2022-07-01$213.81$108.00RVU22C
2022-04-01$213.81$108.00RVU22B
2022-01-01$213.81$108.00RVU22A
2021-10-01$214.01$109.03RVU21D
2021-07-01$214.01$109.03RVU21C
2021-04-01$214.01$109.03RVU21B
2021-01-01$214.01$109.03RVU21A
2020-10-01$197.52$106.83RVU20D
2020-07-01$197.52$106.83RVU20C
2020-04-01$197.52$106.83RVU20B
2020-01-01$197.52$106.83RVU20A
2019-10-01$232.16$132.26RVU19D
2019-07-01$232.16$132.26RVU19C
2019-04-01$232.16$132.26RVU19B
2019-01-01$232.16$132.26RVU19A
2018-10-01$231.04$134.71RVU18D
2018-07-01$231.04$134.71RVU18C
2018-04-01$231.04$134.71RVU18B
2018-01-01$231.04$134.71RVU18AR1
2017-10-01$232.22$136.19RVU17D
2017-07-01$232.22$136.19RVU17C
2017-04-01$232.22$136.19RVU17B
2017-01-01$232.22$136.19RVU17A
2016-10-01$234.27$137.25RVU16D
2016-07-01$234.27$137.25RVU16C
2016-04-01$234.27$137.25RVU16B
2016-01-01$234.27$137.25RVU16A
2015-10-01$234.69$137.75RVU15D
2015-07-01$234.69$137.75RVU15C
2015-04-01$233.52$137.06RVU15B
2015-01-01$233.52$137.06RVU15A
2014-10-01$228.58$131.67RVU14D
2014-07-01$228.58$131.67RVU14C
2014-04-01$228.58$131.67RVU14B
2014-01-01$228.58$131.67RVU14A
2013-10-01$234.48$132.43RVU13D
2013-07-01$234.48$132.43RVU13C
2013-04-01$234.48$132.43RVU13B
2013-01-01$234.48$132.43RVU13AR

Price 40808 for an earlier date of service

Where the Queens, NY rate applies

Queens, NY is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in New York. Some span more than one payment area; confirm with the service ZIP.

Browse all communities in New York

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 Queens, NYGPCI2026.csv, line 81 (RVU26D)

Open CMS sourceHow we calculate rates

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