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

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 West Virginia, Medicare pays $355.32 for 40814 in the office and $253.15 when it’s performed in a hospital or facility.

$355.32Office (non-facility)
$253.15Hospital or facility
−7.0%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 West Virginia
  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 West Virginia 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. West Virginia pays $355.32. The RVUs are the same everywhere; the geographic indexes change the dollars.

40814 in West Virginia vs other payment areas
  1. West Virginia · this page$355.32
  2. Los Angeles, CA · California$428.14+$72.82
  3. Washington, DC area · District of Columbia$434.96+$79.64
  4. Miami, FL · Florida$414.94+$59.62
  5. Chicago, IL · Illinois$403.20+$47.88
  6. Manhattan, NY · New York$439.01+$83.69
  7. Alaska · Alaska$449.23+$93.91

Other areas in West Virginia first, then benchmark localities. Bars start at $0.

Every other payment area

40814 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$344.12$241.25
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

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 West Virginia 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

110

Locality
West Virginia
Physician work
1.000
Practice expense
0.869
Malpractice
1.431
Office calculation for 40814 in West Virginia
ComponentRVULocality factorAdjusted
Physician work3.43× 1.0003.4300
Practice expense7.57× 0.8696.5783
Malpractice0.44× 1.4310.6296
Total RVUs10.6380
Conversion factor× 33.4009

Office rate, West Virginia$355.32

Office: (3.43 × 1 + 7.57 × 0.869 + 0.44 × 1.431) × $33.4009 = $355.32

Facility: (3.43 × 1 + 4.05 × 0.869 + 0.44 × 1.431) × $33.4009 = $253.15

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, West Virginia
Same family
40812Oral lesion excision, simple repairVestibular lesion excision with simple repair rather than complex repair.$259.94
40810Mouth lesion excision, without repairVestibular lesion excision without repair.$196.99
40816Mouth lesion excision, with full-thickness skin graftRelated vestibular lesion excision code for full-thickness excision and closure.$380.28
Used instead
40808Mouth biopsy, oral vestibuleBiopsy when sampling, rather than excision with complex repair, is performed.$153.09

How 40814 has changed in West Virginia

40814 · Office / nonfacility

$355.32

Effective 2026-10-01

The base rate is $20.26 higher than on 2025-10-01, moving from $335.06 to $355.32 (6.0%).

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

    $335.06changed to$355.32

    • 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
    • Practice expense GPCI 0.862 changed to 0.869
    • Malpractice GPCI 1.333 changed to 1.431

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $342.95changed to$335.06

    • 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

    $337.35changed to$342.95

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $349.20changed to$337.35

    • 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
    • Practice expense GPCI 0.860 changed to 0.862
    • Malpractice GPCI 1.266 changed to 1.333

  5. January 1, 2023

    RVU23A

    $352.72changed to$349.20

    • 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
    • Practice expense GPCI 0.858 changed to 0.860
    • Malpractice GPCI 1.198 changed to 1.266

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $357.92changed to$352.72

    • 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

    $360.02changed to$357.92

    • 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
    • Practice expense GPCI 0.857 changed to 0.858
    • Malpractice GPCI 1.247 changed to 1.198

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $369.68changed to$360.02

    • 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
    • Malpractice GPCI 1.296 changed to 1.247

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $369.89changed to$369.68

    • 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

    $369.29changed to$369.89

    • 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
    • Practice expense GPCI 0.847 changed to 0.857
    • Malpractice GPCI 1.289 changed to 1.296

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $367.57changed to$369.29

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 7.18 changed to 7.11
    • Practice expense GPCI 0.836 changed to 0.847
    • Malpractice GPCI 1.282 changed to 1.289

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $368.27changed to$367.57

    • 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

    $366.44changed to$368.27

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $360.79changed to$366.44

    • 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
    • Practice expense GPCI 0.832 changed to 0.836
    • Malpractice GPCI 1.256 changed to 1.282

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $360.69changed to$360.79

    • 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
    • Practice expense GPCI 0.828 changed to 0.832
    • Malpractice GPCI 1.229 changed to 1.256

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $360.69

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$355.32$253.15RVU26D
2026-07-01$355.32$253.15RVU26C
2026-04-01$355.32$253.15RVU26B
2026-01-01$355.32$253.15RVU26A
2025-10-01$335.06$262.28RVU25D
2025-07-01$335.06$262.28RVU25C
2025-04-01$335.06$262.28RVU25B
2025-01-01$335.06$262.28RVU25A
2024-10-01$342.95$266.91RVU24D
2024-07-01$342.95$266.91RVU24C
2024-04-01$342.95$266.91RVU24B
2024-03-09$342.95$266.91RVU24AR
2024-01-01$337.35$262.56RVU24A
2023-10-01$349.20$269.64RVU23D
2023-07-01$349.20$269.64RVU23C
2023-04-01$349.20$269.64RVU23B
2023-01-01$349.20$269.64RVU23A
2022-10-01$352.72$270.17RVU22D
2022-07-01$352.72$270.17RVU22C
2022-04-01$352.72$270.17RVU22B
2022-01-01$352.72$270.17RVU22A
2021-10-01$357.92$273.79RVU21D
2021-07-01$357.92$273.79RVU21C
2021-04-01$357.92$273.79RVU21B
2021-01-01$357.92$273.79RVU21A
2020-10-01$360.02$283.63RVU20D
2020-07-01$360.02$283.63RVU20C
2020-04-01$360.02$283.63RVU20B
2020-01-01$360.02$283.63RVU20A
2019-10-01$369.68$296.17RVU19D
2019-07-01$369.68$296.17RVU19C
2019-04-01$369.68$296.17RVU19B
2019-01-01$369.68$296.17RVU19A
2018-10-01$369.89$299.24RVU18D
2018-07-01$369.89$299.24RVU18C
2018-04-01$369.89$299.24RVU18B
2018-01-01$369.89$299.24RVU18AR1
2017-10-01$369.29$299.98RVU17D
2017-07-01$369.29$299.98RVU17C
2017-04-01$369.29$299.98RVU17B
2017-01-01$369.29$299.98RVU17A
2016-10-01$367.57$299.02RVU16D
2016-07-01$367.57$299.02RVU16C
2016-04-01$367.57$299.02RVU16B
2016-01-01$367.57$299.02RVU16A
2015-10-01$368.27$298.88RVU15D
2015-07-01$368.27$298.88RVU15C
2015-04-01$366.44$297.39RVU15B
2015-01-01$366.44$297.39RVU15A
2014-10-01$360.79$293.73RVU14D
2014-07-01$360.79$293.73RVU14C
2014-04-01$360.79$293.73RVU14B
2014-01-01$360.79$293.73RVU14A
2013-10-01$360.69$289.70RVU13D
2013-07-01$360.69$289.70RVU13C
2013-04-01$360.69$289.70RVU13B
2013-01-01$360.69$289.70RVU13AR

Price 40814 for an earlier date of service

Where the West Virginia rate applies

West Virginia is a Medicare payment area, not a city. Our Census mapping connects it to 439 cities and communities in West Virginia. Some span more than one payment area; confirm with the service ZIP.

  • Accoville
  • Addison (Webster Springs)
  • Adrian
  • Albright
  • Alderson
  • Alum Creek
  • Amherstdale
  • Anawalt

Browse all communities in West Virginia

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 West VirginiaGPCI2026.csv, line 110 (RVU26D)

Open CMS sourceHow we calculate rates

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