CPT code 40810: Mouth lesion excision, without repair2026 Medicare rate & RVUs

Medicare pays $216.10 for 40810 nationally in the office and $114.90 in a hospital or facility. Local office rates run $189.83–$291.43.

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

What 40810 covers

This service removes a lesion from the lining and underlying tissue of the oral vestibule, the space between the lips or cheeks and the teeth or gums. It may be performed by an oral and maxillofacial surgeon, dentist, or other qualified clinician in an office or surgical setting. A persistent or suspicious inner-lip or cheek lesion may be excised for treatment or tissue diagnosis; the specimen can be submitted for pathologic examination.

Choose this code when the documented work is excision in the vestibule and no repair is performed. If the operative note describes repair, compare the repair-specific codes in this family rather than reporting this code. Document the precise site, lesion and extent removed, and whether repair was performed. The service has a 10-day global period, which includes related postoperative visits during that period. 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% reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service; 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.

Where 40810 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

40810 rates by state

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

How the 40810 rate is calculated

Each of 40810’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.

Payment rules and modifiers for 40810

40810 has a 10-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 51

40810 compared with similar codes

How to choose

40808Mouth biopsyOral vestibule

40808 describes biopsy of a mouth lesion. Choose 40810 when the documented service is excision of a lesion from the oral vestibule without repair.

40812Oral lesion excisionSimple repair

40812 is the related vestibular lesion excision code when simple repair is performed; 40810 is for excision without repair.

40814Oral lesion excisionComplex repair

40814 is used for vestibular lesion excision involving complex repair, unlike 40810, which is reported when no repair is performed.

40800Oral drainageSimple vestibular drainage

40800 describes drainage of a mouth lesion. Use 40810 when the lesion is excised rather than drained.

Codes related to 40810

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

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

Open CMS sourceHow we calculate rates