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CPT code 40812: Oral lesion excision, simple repair2026 Medicare rate & RVUs in South Carolina

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 South Carolina, Medicare pays $265.01 for 40812 in the office and $160.69 when it’s performed in a hospital or facility.

$265.01Office (non-facility)
$160.69Hospital or facility
−5.8%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 South Carolina
  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 South Carolina 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. South Carolina pays $265.01. The RVUs are the same everywhere; the geographic indexes change the dollars.

40812 in South Carolina vs other payment areas
  1. South Carolina · this page$265.01
  2. Los Angeles, CA · California$316.72+$51.71
  3. Washington, DC area · District of Columbia$321.10+$56.09
  4. Miami, FL · Florida$304.02+$39.01
  5. Chicago, IL · Illinois$295.29+$30.28
  6. Manhattan, NY · New York$323.34+$58.33
  7. Alaska · Alaska$328.10+$63.09

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

Every other payment area

40812 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$252.73$153.95
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

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 South Carolina 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

93

Locality
South Carolina
Physician work
1.000
Practice expense
0.924
Malpractice
0.850
Office calculation for 40812 in South Carolina
ComponentRVULocality factorAdjusted
Physician work2.31× 1.0002.3100
Practice expense5.82× 0.9245.3777
Malpractice0.29× 0.8500.2465
Total RVUs7.9342
Conversion factor× 33.4009

Office rate, South Carolina$265.01

Office: (2.31 × 1 + 5.82 × 0.924 + 0.29 × 0.85) × $33.4009 = $265.01

Facility: (2.31 × 1 + 2.44 × 0.924 + 0.29 × 0.85) × $33.4009 = $160.69

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, South Carolina
Used instead
40808Mouth biopsy, oral vestibuleDiagnostic biopsy of a mouth lesion rather than excision with simple repair.$157.48
Same family
40810Mouth lesion excision, without repairVestibular lesion excision without repair.$202.61
40814Oral lesion excision, complex repairVestibular lesion excision with complex repair.$360.69
40816Mouth lesion excision, with full-thickness skin graftMore extensive, radical resection of a vestibular lesion.$385.58

How 40812 has changed in South Carolina

40812 · Office / nonfacility

$265.01

Effective 2026-10-01

The base rate is $14.59 higher than on 2025-10-01, moving from $250.42 to $265.01 (5.8%).

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

    $250.42changed to$265.01

    • 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
    • Practice expense GPCI 0.913 changed to 0.924
    • Malpractice GPCI 0.817 changed to 0.850

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $259.19changed to$250.42

    • 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

    $254.96changed to$259.19

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $266.67changed to$254.96

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 5.84 changed to 5.70
    • Practice expense GPCI 0.908 changed to 0.913
    • Malpractice GPCI 0.756 changed to 0.817

  5. January 1, 2023

    RVU23A

    $273.65changed to$266.67

    • 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
    • Practice expense GPCI 0.903 changed to 0.908
    • Malpractice GPCI 0.695 changed to 0.756

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $276.55changed to$273.65

    • 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

    $273.38changed to$276.55

    • 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
    • Practice expense GPCI 0.907 changed to 0.903
    • Malpractice GPCI 0.624 changed to 0.695

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $275.27changed to$273.38

    • 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
    • Practice expense GPCI 0.912 changed to 0.907
    • Malpractice GPCI 0.553 changed to 0.624

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $275.10changed to$275.27

    • 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

    $277.88changed to$275.10

    • 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
    • Malpractice GPCI 0.634 changed to 0.553

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $280.31changed to$277.88

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 5.68 changed to 5.62
    • Malpractice GPCI 0.715 changed to 0.634

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $280.74changed to$280.31

    • 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

    $279.34changed to$280.74

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $276.58changed to$279.34

    • Conversion factor 35.8228 changed to 35.7547
    • Malpractice RVU 0.30 changed to 0.38
    • Practice expense GPCI 0.911 changed to 0.912
    • Malpractice GPCI 0.618 changed to 0.715

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $277.87changed to$276.58

    • 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
    • Practice expense GPCI 0.909 changed to 0.911
    • Malpractice GPCI 0.520 changed to 0.618

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $277.87

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$265.01$160.69RVU26D
2026-07-01$265.01$160.69RVU26C
2026-04-01$265.01$160.69RVU26B
2026-01-01$265.01$160.69RVU26A
2025-10-01$250.42$168.62RVU25D
2025-07-01$250.42$168.62RVU25C
2025-04-01$250.42$168.62RVU25B
2025-01-01$250.42$168.62RVU25A
2024-10-01$259.19$172.58RVU24D
2024-07-01$259.19$172.58RVU24C
2024-04-01$259.19$172.58RVU24B
2024-03-09$259.19$172.58RVU24AR
2024-01-01$254.96$169.76RVU24A
2023-10-01$266.67$175.28RVU23D
2023-07-01$266.67$175.28RVU23C
2023-04-01$266.67$175.28RVU23B
2023-01-01$266.67$175.28RVU23A
2022-10-01$273.65$177.09RVU22D
2022-07-01$273.65$177.09RVU22C
2022-04-01$273.65$177.09RVU22B
2022-01-01$273.65$177.09RVU22A
2021-10-01$276.55$178.56RVU21D
2021-07-01$276.55$178.56RVU21C
2021-04-01$276.55$178.56RVU21B
2021-01-01$276.55$178.56RVU21A
2020-10-01$273.38$183.70RVU20D
2020-07-01$273.38$183.70RVU20C
2020-04-01$273.38$183.70RVU20B
2020-01-01$273.38$183.70RVU20A
2019-10-01$275.27$187.52RVU19D
2019-07-01$275.27$187.52RVU19C
2019-04-01$275.27$187.52RVU19B
2019-01-01$275.27$187.52RVU19A
2018-10-01$275.10$189.74RVU18D
2018-07-01$275.10$189.74RVU18C
2018-04-01$275.10$189.74RVU18B
2018-01-01$275.10$189.74RVU18AR1
2017-10-01$277.88$192.78RVU17D
2017-07-01$277.88$192.78RVU17C
2017-04-01$277.88$192.78RVU17B
2017-01-01$277.88$192.78RVU17A
2016-10-01$280.31$194.76RVU16D
2016-07-01$280.31$194.76RVU16C
2016-04-01$280.31$194.76RVU16B
2016-01-01$280.31$194.76RVU16A
2015-10-01$280.74$195.21RVU15D
2015-07-01$280.74$195.21RVU15C
2015-04-01$279.34$194.23RVU15B
2015-01-01$279.34$194.23RVU15A
2014-10-01$276.58$191.73RVU14D
2014-07-01$276.58$191.73RVU14C
2014-04-01$276.58$191.73RVU14B
2014-01-01$276.58$191.73RVU14A
2013-10-01$277.87$188.80RVU13D
2013-07-01$277.87$188.80RVU13C
2013-04-01$277.87$188.80RVU13B
2013-01-01$277.87$188.80RVU13AR

Price 40812 for an earlier date of service

Where the South Carolina rate applies

South Carolina is a Medicare payment area, not a city. Our Census mapping connects it to 475 cities and communities in South Carolina. Some span more than one payment area; confirm with the service ZIP.

  • Abbeville
  • Abney Crossroads
  • Adams Run
  • Aiken
  • Alcolu
  • Allendale
  • Anderson
  • Andrews

Browse all communities in South Carolina

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 South CarolinaGPCI2026.csv, line 93 (RVU26D)

Open CMS sourceHow we calculate rates

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