FeeBase
Log inGet started
Menu

CPT code 40812: Oral lesion excision, simple repair2026 Medicare rate & RVUs in Washington, DC area

Reports excision of a lesion in the mouth vestibule when the resulting defect is closed with a simple repair.

CMS RVU26DEffective Oct 1, 2026One payment locality5.2K Medicare services in 2024

In Washington, DC area, Medicare pays $321.10 for 40812 in the office and $188.11 when it’s performed in a hospital or facility.

$321.10Office (non-facility)
$188.11Hospital or facility
+14.2%vs the national office rate ($281.24)

Check a contract rate as a % of Medicare · 40812 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 40812 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Washington, DC area
  2. What 40812 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 40812 covers

The clinician removes a lesion from the oral vestibule, the space between the lips or cheeks and the teeth or gums, and closes the resulting defect with a simple repair. Oral and maxillofacial surgeons, otolaryngologists, and other clinicians who perform oral surgery may provide this service in an office or facility setting. The code describes lesion removal with closure, rather than a diagnostic tissue sample alone or treatment of an abscess.

Report the code when the operative note identifies the vestibular site, excision, and simple repair. A 10-day global period includes related postoperative visits during that period. When multiple procedures are performed in the same session, Medicare pays the highest-valued procedure in full and reduces the others to 50%. Modifier 50 is inappropriate for this code’s anatomy. Medicare does not pay an assistant at surgery; 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 Washington, DC area compares for 40812

Across 109 of 109 payment localities, the office rate for 40812 runs from $249.13 in Arkansas to $371.15 in San Benito County, CA. Washington, DC area pays $321.10. The RVUs are the same everywhere; the geographic indexes change the dollars.

40812 in Washington, DC area vs other payment areas
  1. Washington, DC area · this page$321.10
  2. Los Angeles, CA · California$316.72−$4.38
  3. Miami, FL · Florida$304.02−$17.08
  4. Chicago, IL · Illinois$295.29−$25.81
  5. Manhattan, NY · New York$323.34+$2.24
  6. Alaska · Alaska$328.10+$7.00
  7. Alabama · Alabama$252.73−$68.37

Other areas in District of Columbia first, then benchmark localities. Bars start at $0.

Every other payment area

40812 in every other Medicare payment locality
Payment localityOfficeFacility
ArkansasArkansas$249.13$152.15
ArizonaArizona$273.81$164.42
Bakersfield, CACalifornia$297.58$173.84
Chico, CACalifornia$296.71$172.98
El Centro, CACalifornia$296.76$173.03
Fresno, CACalifornia$296.71$172.98
Hanford, CACalifornia$296.71$172.98
Madera, CACalifornia$296.71$172.98

40812 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.

$249.13

$333.93

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

View every state and territory as a table
40812 office rate range by state
State / territoryOffice rate rangeLocalities
AK$328.101
AL$252.731
AR$249.131
AZ$273.811
CA$296.71–$371.1529
CO$292.481
CT$299.781
DC$321.101
DE$278.311
FL$277.55–$304.023
GA$262.10–$286.522
GU$303.791
HI$303.791
IA$258.871
ID$260.581
IL$269.78–$295.294
IN$262.071
KS$257.771
KY$258.831
LA$258.47–$271.082
MA$290.81–$321.052
MD$283.55–$321.103
ME$262.02–$275.912
MI$265.57–$281.082
MN$280.051
MO$254.16–$271.923
MS$251.691
MT$281.221
NC$264.711
ND$275.481
NE$260.241
NH$287.991
NJ$303.15–$317.862
NM$267.051
NV$279.811
NY$268.64–$331.225
OH$264.401
OK$258.281
OR$277.58–$301.572
PA$264.76–$292.462
PR$283.231
RI$288.071
SC$265.011
SD$274.801
TN$259.061
TX$263.05–$291.568
UT$268.581
VA$275.08–$321.102
VI$283.231
VT$274.511
WA$290.23–$327.452
WI$266.371
WV$259.941
WY$278.721

See 40812 in every payment locality

How the 40812 rate is calculated

Each of 40812’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 · 40812

RVUs × geographic indexes × conversion factor

Office or facility?

Work2.31

2.31 RVUs× 1.000 GPCI

Practice expense5.82

5.82 RVUs× 1.000 GPCI

Malpractice0.29

0.29 RVUs× 1.000 GPCI

Adjusted RVUs

8.4200

Conversion factor

$33.4009

Medicare rate

$281.24

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

The exact Washington, DC area inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

4,864

Code
40812
Physician work
2.31
Practice expense
5.82
Malpractice
0.29

GPCI2026.csv

39

Locality
Washington, DC area
Physician work
1.054
Practice expense
1.178
Malpractice
1.113
Office calculation for 40812 in Washington, DC area
ComponentRVULocality factorAdjusted
Physician work2.31× 1.0542.4347
Practice expense5.82× 1.1786.8560
Malpractice0.29× 1.1130.3228
Total RVUs9.6135
Conversion factor× 33.4009

Office rate, Washington, DC area$321.10

Office: (2.31 × 1.054 + 5.82 × 1.178 + 0.29 × 1.113) × $33.4009 = $321.10

Facility: (2.31 × 1.054 + 2.44 × 1.178 + 0.29 × 1.113) × $33.4009 = $188.11

Open 40812 in the RVU calculator

Payment rules and modifiers for 40812

40812 has a 10-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 40812

Oral lesion excision, simple repair

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 · 40812

Oral lesion excision, simple repair

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

40812 without 51 · national office

$281.24

Oral lesion excision, simple repair

40812-51 · Second procedure: 50%

$140.62

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 40812

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

Codes related to 40812
CodeHow it relatesOffice range, Washington, DC area
Used instead
40808Mouth biopsy, oral vestibuleDiagnostic biopsy of a mouth lesion rather than excision with simple repair.$193.38
Same family
40810Mouth lesion excision, without repairVestibular lesion excision without repair.$248.67
40814Oral lesion excision, complex repairVestibular lesion excision with complex repair.$434.96
40816Mouth lesion excision, with full-thickness skin graftMore extensive, radical resection of a vestibular lesion.$464.90

How 40812 has changed in Washington, DC area

40812 · Office / nonfacility

$321.10

Effective 2026-10-01

The base rate is $12.39 higher than on 2025-10-01, moving from $308.71 to $321.10 (4.0%).

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

    $308.71changed to$321.10

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.37 changed to 2.31
    • Practice expense RVU 5.66 changed to 5.82
    • Malpractice RVU 0.25 changed to 0.29
    • Work GPCI 1.057 changed to 1.054
    • Practice expense GPCI 1.192 changed to 1.178
    • Malpractice GPCI 1.168 changed to 1.113

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $319.67changed to$308.71

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 5.70 changed to 5.66
    • Malpractice RVU 0.26 changed to 0.25

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $314.45changed to$319.67

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $335.91changed to$314.45

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 5.84 changed to 5.70
    • Work GPCI 1.056 changed to 1.057
    • Practice expense GPCI 1.214 changed to 1.192
    • Malpractice GPCI 1.231 changed to 1.168

  5. January 1, 2023

    RVU23A

    $351.71changed to$335.91

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 5.94 changed to 5.84
    • Malpractice RVU 0.25 changed to 0.26
    • Work GPCI 1.054 changed to 1.056
    • Practice expense GPCI 1.236 changed to 1.214
    • Malpractice GPCI 1.294 changed to 1.231

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $355.49changed to$351.71

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 5.96 changed to 5.94

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $346.71changed to$355.49

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 5.56 changed to 5.96
    • Malpractice RVU 0.26 changed to 0.25
    • Work GPCI 1.049 changed to 1.054
    • Practice expense GPCI 1.221 changed to 1.236
    • Malpractice GPCI 1.277 changed to 1.294

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $347.57changed to$346.71

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 5.54 changed to 5.56
    • Malpractice RVU 0.39 changed to 0.26
    • Work GPCI 1.045 changed to 1.049
    • Practice expense GPCI 1.205 changed to 1.221
    • Malpractice GPCI 1.261 changed to 1.277

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $347.17changed to$347.57

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 5.55 changed to 5.54
    • Malpractice RVU 0.38 changed to 0.39

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $349.97changed to$347.17

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 5.62 changed to 5.55
    • Malpractice RVU 0.39 changed to 0.38
    • Work GPCI 1.048 changed to 1.045
    • Malpractice GPCI 1.271 changed to 1.261

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $352.12changed to$349.97

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 5.68 changed to 5.62
    • Work GPCI 1.051 changed to 1.048
    • Malpractice GPCI 1.280 changed to 1.271

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $352.49changed to$352.12

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 5.67 changed to 5.68
    • Malpractice RVU 0.38 changed to 0.39

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $350.74changed to$352.49

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $346.24changed to$350.74

    • Conversion factor 35.8228 changed to 35.7547
    • Malpractice RVU 0.30 changed to 0.38
    • Work GPCI 1.050 changed to 1.051
    • Practice expense GPCI 1.202 changed to 1.205
    • Malpractice GPCI 1.205 changed to 1.280

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $349.21changed to$346.24

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 6.20 changed to 5.67
    • Malpractice RVU 0.31 changed to 0.30
    • Work GPCI 1.049 changed to 1.050
    • Practice expense GPCI 1.198 changed to 1.202
    • Malpractice GPCI 1.130 changed to 1.205

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $349.21

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$321.10$188.11RVU26D
2026-07-01$321.10$188.11RVU26C
2026-04-01$321.10$188.11RVU26B
2026-01-01$321.10$188.11RVU26A
2025-10-01$308.71$201.91RVU25D
2025-07-01$308.71$201.91RVU25C
2025-04-01$308.71$201.91RVU25B
2025-01-01$308.71$201.91RVU25A
2024-10-01$319.67$206.58RVU24D
2024-07-01$319.67$206.58RVU24C
2024-04-01$319.67$206.58RVU24B
2024-03-09$319.67$206.58RVU24AR
2024-01-01$314.45$203.21RVU24A
2023-10-01$335.91$213.73RVU23D
2023-07-01$335.91$213.73RVU23C
2023-04-01$335.91$213.73RVU23B
2023-01-01$335.91$213.73RVU23A
2022-10-01$351.71$219.54RVU22D
2022-07-01$351.71$219.54RVU22C
2022-04-01$351.71$219.54RVU22B
2022-01-01$351.71$219.54RVU22A
2021-10-01$355.49$221.36RVU21D
2021-07-01$355.49$221.36RVU21C
2021-04-01$355.49$221.36RVU21B
2021-01-01$355.49$221.36RVU21A
2020-10-01$346.71$225.97RVU20D
2020-07-01$346.71$225.97RVU20C
2020-04-01$346.71$225.97RVU20B
2020-01-01$346.71$225.97RVU20A
2019-10-01$347.57$231.62RVU19D
2019-07-01$347.57$231.62RVU19C
2019-04-01$347.57$231.62RVU19B
2019-01-01$347.57$231.62RVU19A
2018-10-01$347.17$234.38RVU18D
2018-07-01$347.17$234.38RVU18C
2018-04-01$347.17$234.38RVU18B
2018-01-01$347.17$234.38RVU18AR1
2017-10-01$349.97$237.53RVU17D
2017-07-01$349.97$237.53RVU17C
2017-04-01$349.97$237.53RVU17B
2017-01-01$349.97$237.53RVU17A
2016-10-01$352.12$239.08RVU16D
2016-07-01$352.12$239.08RVU16C
2016-04-01$352.12$239.08RVU16B
2016-01-01$352.12$239.08RVU16A
2015-10-01$352.49$239.48RVU15D
2015-07-01$352.49$239.48RVU15C
2015-04-01$350.74$238.29RVU15B
2015-01-01$350.74$238.29RVU15A
2014-10-01$346.24$234.29RVU14D
2014-07-01$346.24$234.29RVU14C
2014-04-01$346.24$234.29RVU14B
2014-01-01$346.24$234.29RVU14A
2013-10-01$349.21$231.83RVU13D
2013-07-01$349.21$231.83RVU13C
2013-04-01$349.21$231.83RVU13B
2013-01-01$349.21$231.83RVU13AR

Price 40812 for an earlier date of service

Where the Washington, DC area rate applies

Washington, DC area is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in District of Columbia. Some span more than one payment area; confirm with the service ZIP.

  • Washington

Browse all communities in District of Columbia

40812 billing questions

How does this differ from 40810?

40812 includes simple repair of the defect after lesion excision. 40810 describes excision without repair.

When is 40814 more appropriate?

Use 40814 when the excision requires complex repair. The operative note should support the repair performed, not just the lesion’s size or diagnosis.

Can 40812 be reported for a biopsy?

A diagnostic sample without definitive lesion removal points to 40808. Report 40812 when the lesion is excised and the defect receives simple repair.

Should modifier 50 be appended for lesions on both sides?

No. Modifier 50 is inappropriate for this oral-vestibule service.

How are other procedures in the same session paid?

Medicare pays the highest-valued procedure in full and reduces other procedures in the session to 50%. Related postoperative visits during the 10-day global period are included.

Does Medicare pay an assistant or co-surgeon for this service?

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

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 40812PPRRVU2026_Oct_nonQPP.csv, line 4,864 (RVU26D)
Geographic factors for Washington, DC areaGPCI2026.csv, line 39 (RVU26D)

Open CMS sourceHow we calculate rates

Did this answer your question about what 40812 pays in Washington, DC area?

Tell us what you were actually trying to work out. We’ll answer you directly, or build the page that does.

Fee sheets · Coming soon

Put 40812 and the rest of your codes on one sheet

Your codes at your locality, with payer contracts beside Medicare.

Join the waitlist