CPT code 40814: Oral lesion excision, complex repair2026 Medicare rate & RVUs

Medicare pays $382.11 for 40814 nationally in the office and $264.54 in a hospital or facility. Local office rates run $339.33–$499.65.

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

What 40814 covers

Code 40814 describes excision of a lesion from the mucosa and submucosa of the mouth vestibule, followed by complex repair. The vestibule is the space between the lips or cheeks and the teeth or gums; examples include the inner lip or cheek lining. Oral and maxillofacial surgeons, otolaryngologists, and other surgeons may perform the procedure in an office, ambulatory surgery center, or hospital. A specimen may be sent for pathologic examination, but the operative service is selected by the excision and repair performed, not by the final diagnosis.

Choose this code when the operative report supports a complex repair, rather than no repair or simple repair. Document the lesion’s site, the excision performed, and the repair technique and complexity. Medicare assigns a 90-day global period, which includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in one session, the highest-valued procedure is paid in full and the others at 50%. Modifier 50 is inappropriate. Assistant-at-surgery payment is restricted; 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 40814 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

40814 rates by state

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

How the 40814 rate is calculated

Each of 40814’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 40814

40814 has a 90-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

40814 compared with similar codes

How to choose

40812Oral lesion excisionSimple repair

Both involve excision of a vestibular mouth lesion and repair. The repair documented for 40814 must be complex; 40812 describes simple repair.

40810Mouth lesion excisionWithout repair

40810 is for excision without repair. Choose 40814 when the site is closed with a complex repair.

40816Mouth lesion excisionWith full-thickness skin graft

40816 describes full-thickness excision and closure. 40814 applies to mucosa and submucosa excision with complex repair.

40808Mouth biopsyOral vestibule

40808 is for biopsy of a mouth lesion. 40814 is for lesion excision with complex repair, rather than sampling alone.

Codes related to 40814

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