FeeBase
Log inGet started
Menu

CPT code 40814: Oral lesion excision, complex repair2026 Medicare rate & RVUs in Washington, DC area

Report this service when a lesion of the mouth vestibule is excised and the resulting site requires complex repair.

CMS RVU26DEffective Oct 1, 2026One payment locality587 Medicare services in 2024

In Washington, DC area, Medicare pays $434.96 for 40814 in the office and $296.46 when it’s performed in a hospital or facility.

$434.96Office (non-facility)
$296.46Hospital or facility
+13.8%vs the national office rate ($382.11)

Check a contract rate as a % of Medicare · 40814 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 40814 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Washington, DC area
  2. What 40814 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 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.

How Washington, DC area compares for 40814

Across 109 of 109 payment localities, the office rate for 40814 runs from $339.33 in Arkansas to $499.65 in San Benito County, CA. Washington, DC area pays $434.96. The RVUs are the same everywhere; the geographic indexes change the dollars.

40814 in Washington, DC area vs other payment areas
  1. Washington, DC area · this page$434.96
  2. Los Angeles, CA · California$428.14−$6.82
  3. Miami, FL · Florida$414.94−$20.02
  4. Chicago, IL · Illinois$403.20−$31.76
  5. Manhattan, NY · New York$439.01+$4.05
  6. Alaska · Alaska$449.23+$14.27
  7. Alabama · Alabama$344.12−$90.84

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

Every other payment area

40814 in every other Medicare payment locality
Payment localityOfficeFacility
ArkansasArkansas$339.33$238.33
ArizonaArizona$372.15$258.23
Bakersfield, CACalifornia$402.81$273.95
Chico, CACalifornia$401.51$272.65
El Centro, CACalifornia$401.58$272.72
Fresno, CACalifornia$401.51$272.65
Hanford, CACalifornia$401.51$272.65
Madera, CACalifornia$401.51$272.65

40814 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.

$339.33

$450.58

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

View every state and territory as a table
40814 office rate range by state
State / territoryOffice rate rangeLocalities
AK$449.231
AL$344.121
AR$339.331
AZ$372.151
CA$401.51–$499.6529
CO$396.441
CT$406.951
DC$434.961
DE$378.161
FL$378.37–$414.943
GA$357.62–$389.452
GU$410.561
HI$410.561
IA$351.751
ID$354.131
IL$368.38–$403.204
IN$356.091
KS$350.541
KY$352.791
LA$352.41–$369.192
MA$394.36–$434.242
MD$385.08–$434.963
ME$356.32–$374.412
MI$362.00–$383.342
MN$379.091
MO$346.83–$370.003
MS$343.131
MT$382.081
NC$359.861
ND$373.381
NE$353.501
NH$390.641
NJ$411.38–$430.782
NM$364.071
NV$379.901
NY$365.10–$449.825
OH$360.231
OK$351.771
OR$376.73–$408.242
PA$360.56–$397.372
PR$384.671
RI$391.041
SC$360.691
SD$372.351
TN$352.291
TX$358.31–$395.338
UT$365.441
VA$373.49–$434.962
VI$384.671
VT$372.321
WA$393.48–$442.542
WI$361.321
WV$355.321
WY$378.291

See 40814 in every payment locality

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.

How the rate is built · 40814

RVUs × geographic indexes × conversion factor

Office or facility?

Work3.43

3.43 RVUs× 1.000 GPCI

Practice expense7.57

7.57 RVUs× 1.000 GPCI

Malpractice0.44

0.44 RVUs× 1.000 GPCI

Adjusted RVUs

11.4400

Conversion factor

$33.4009

Medicare rate

$382.11

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

4,865

Code
40814
Physician work
3.43
Practice expense
7.57
Malpractice
0.44

GPCI2026.csv

39

Locality
Washington, DC area
Physician work
1.054
Practice expense
1.178
Malpractice
1.113
Office calculation for 40814 in Washington, DC area
ComponentRVULocality factorAdjusted
Physician work3.43× 1.0543.6152
Practice expense7.57× 1.1788.9175
Malpractice0.44× 1.1130.4897
Total RVUs13.0224
Conversion factor× 33.4009

Office rate, Washington, DC area$434.96

Office: (3.43 × 1.054 + 7.57 × 1.178 + 0.44 × 1.113) × $33.4009 = $434.96

Facility: (3.43 × 1.054 + 4.05 × 1.178 + 0.44 × 1.113) × $33.4009 = $296.46

Open 40814 in the RVU calculator

Payment rules and modifiers for 40814

40814 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 40814

Oral lesion excision, complex repair

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 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)0.09/0.81/0.10Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 40814

Oral lesion excision, complex repair

90-day global period ends

Dec 30, 2026

Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).

Visit on Oct 31, 2026

Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

40814 without 51 · national office

$382.11

Oral lesion excision, complex repair

40814-51 · Second procedure: 50%

$191.06

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 40814

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

Codes related to 40814
CodeHow it relatesOffice range, Washington, DC area
Same family
40812Oral lesion excision, simple repairVestibular lesion excision with simple repair rather than complex repair.$321.10
40810Mouth lesion excision, without repairVestibular lesion excision without repair.$248.67
40816Mouth lesion excision, with full-thickness skin graftRelated vestibular lesion excision code for full-thickness excision and closure.$464.90
Used instead
40808Mouth biopsy, oral vestibuleBiopsy when sampling, rather than excision with complex repair, is performed.$193.38

How 40814 has changed in Washington, DC area

40814 · Office / nonfacility

$434.96

Effective 2026-10-01

The base rate is $17.25 higher than on 2025-10-01, moving from $417.71 to $434.96 (4.1%).

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

    $417.71changed to$434.96

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 3.52 changed to 3.43
    • Practice expense RVU 7.33 changed to 7.57
    • Malpractice RVU 0.39 changed to 0.44
    • 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

    $427.07changed to$417.71

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 7.25 changed to 7.33
    • Malpractice RVU 0.40 changed to 0.39

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $420.10changed to$427.07

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $443.36changed to$420.10

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 7.33 changed to 7.25
    • Malpractice RVU 0.38 changed to 0.40
    • 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

    $455.49changed to$443.36

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 7.26 changed to 7.33
    • Malpractice RVU 0.37 changed to 0.38
    • 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

    $462.70changed to$455.49

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 7.35 changed to 7.26
    • Malpractice RVU 0.36 changed to 0.37

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $458.35changed to$462.70

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 6.98 changed to 7.35
    • Malpractice RVU 0.38 changed to 0.36
    • 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

    $462.46changed to$458.35

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 7.00 changed to 6.98
    • Malpractice RVU 0.57 changed to 0.38
    • 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

    $462.82changed to$462.46

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 7.02 changed to 7.00

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $466.33changed to$462.82

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 7.11 changed to 7.02
    • Malpractice RVU 0.58 changed to 0.57
    • 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

    $468.82changed to$466.33

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 7.18 changed to 7.11
    • 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

    $470.02changed to$468.82

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 7.19 changed to 7.18
    • Malpractice RVU 0.56 changed to 0.58

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $467.68changed to$470.02

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $461.42changed to$467.68

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 7.18 changed to 7.19
    • Malpractice RVU 0.46 changed to 0.56
    • 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

    $463.64changed to$461.42

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 7.84 changed to 7.18
    • Malpractice RVU 0.48 changed to 0.46
    • 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: $463.64

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$434.96$296.46RVU26D
2026-07-01$434.96$296.46RVU26C
2026-04-01$434.96$296.46RVU26B
2026-01-01$434.96$296.46RVU26A
2025-10-01$417.71$317.07RVU25D
2025-07-01$417.71$317.07RVU25C
2025-04-01$417.71$317.07RVU25B
2025-01-01$417.71$317.07RVU25A
2024-10-01$427.07$321.92RVU24D
2024-07-01$427.07$321.92RVU24C
2024-04-01$427.07$321.92RVU24B
2024-03-09$427.07$321.92RVU24AR
2024-01-01$420.10$316.67RVU24A
2023-10-01$443.36$331.05RVU23D
2023-07-01$443.36$331.05RVU23C
2023-04-01$443.36$331.05RVU23B
2023-01-01$443.36$331.05RVU23A
2022-10-01$455.49$336.58RVU22D
2022-07-01$455.49$336.58RVU22C
2022-04-01$455.49$336.58RVU22B
2022-01-01$455.49$336.58RVU22A
2021-10-01$462.70$341.51RVU21D
2021-07-01$462.70$341.51RVU21C
2021-04-01$462.70$341.51RVU21B
2021-01-01$462.70$341.51RVU21A
2020-10-01$458.35$349.51RVU20D
2020-07-01$458.35$349.51RVU20C
2020-04-01$458.35$349.51RVU20B
2020-01-01$458.35$349.51RVU20A
2019-10-01$462.46$359.10RVU19D
2019-07-01$462.46$359.10RVU19C
2019-04-01$462.46$359.10RVU19B
2019-01-01$462.46$359.10RVU19A
2018-10-01$462.82$363.48RVU18D
2018-07-01$462.82$363.48RVU18C
2018-04-01$462.82$363.48RVU18B
2018-01-01$462.82$363.48RVU18AR1
2017-10-01$466.33$367.73RVU17D
2017-07-01$466.33$367.73RVU17C
2017-04-01$466.33$367.73RVU17B
2017-01-01$466.33$367.73RVU17A
2016-10-01$468.82$370.01RVU16D
2016-07-01$468.82$370.01RVU16C
2016-04-01$468.82$370.01RVU16B
2016-01-01$468.82$370.01RVU16A
2015-10-01$470.02$370.00RVU15D
2015-07-01$470.02$370.00RVU15C
2015-04-01$467.68$368.16RVU15B
2015-01-01$467.68$368.16RVU15A
2014-10-01$461.42$364.54RVU14D
2014-07-01$461.42$364.54RVU14C
2014-04-01$461.42$364.54RVU14B
2014-01-01$461.42$364.54RVU14A
2013-10-01$463.64$360.92RVU13D
2013-07-01$463.64$360.92RVU13C
2013-04-01$463.64$360.92RVU13B
2013-01-01$463.64$360.92RVU13AR

Price 40814 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

40814 billing questions

How does 40814 differ from 40812?

Both describe vestibular lesion excision with repair. Use 40814 when the documentation supports complex repair; 40812 is for simple repair.

When is 40810 a better choice?

40810 describes excision without repair. Use 40814 when the excision site receives a complex repair.

Should 40814 be reported for a biopsy?

Use 40814 for excision with complex repair, not for a diagnostic sample alone. Code 40808 describes biopsy of a mouth lesion.

Can modifier 50 be appended for lesions on both sides?

No. CMS identifies bilateral adjustment as inappropriate for this code.

What postoperative care is included?

The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.

Can an assistant or co-surgeon be paid?

Assistant-at-surgery payment is restricted 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 40814PPRRVU2026_Oct_nonQPP.csv, line 4,865 (RVU26D)
Geographic factors for Washington, DC areaGPCI2026.csv, line 39 (RVU26D)

Open CMS sourceHow we calculate rates

Did this answer your question about what 40814 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 40814 and the rest of your codes on one sheet

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

Join the waitlist