CPT code 40816: Mouth lesion excision, with full-thickness skin graft2026 Medicare rate & RVUs in South Carolina
Excision of a vestibular mouth lesion followed by full-thickness skin graft closure, reported when the defect requires graft reconstruction rather than routine repair.
In South Carolina, Medicare pays $385.58 for 40816 in the office and $266.76 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 40816 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What 40816 covers
This service removes a lesion involving the mucosa and submucosa of the oral vestibule, the space between the lips or cheeks and the teeth or gums, and closes the resulting defect with a full-thickness skin graft. Oral and maxillofacial surgeons, otolaryngologists, and other surgeons who treat oral lesions may perform it. The operative note should identify the vestibular site, lesion excision, defect, and graft reconstruction.
Report this code when the lesion is excised and the defect is closed with a full-thickness skin graft, rather than with no repair or routine closure. Documentation should support the graft technique and the work performed. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate; assistant-at-surgery payment is restricted, and 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 40816
Across 109 of 109 payment localities, the office rate for 40816 runs from $362.60 in Arkansas to $533.41 in San Benito County, CA. South Carolina pays $385.58. The RVUs are the same everywhere; the geographic indexes change the dollars.
- South Carolina · this page$385.58
- Los Angeles, CA · California$457.30+$71.72
- Washington, DC area · District of Columbia$464.90+$79.32
- Miami, FL · Florida$444.55+$58.97
- Chicago, IL · Illinois$431.89+$46.31
- Manhattan, NY · New York$469.56+$83.98
- Alaska · Alaska$480.10+$94.52
Other areas in South Carolina first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $367.74 | $255.22 |
| ArkansasArkansas | $362.60 | $252.13 |
| ArizonaArizona | $397.79 | $273.18 |
| Bakersfield, CACalifornia | $430.27 | $289.33 |
| Chico, CACalifornia | $428.83 | $287.89 |
| El Centro, CACalifornia | $428.91 | $287.98 |
| Fresno, CACalifornia | $428.83 | $287.89 |
| Hanford, CACalifornia | $428.83 | $287.89 |
| Madera, CACalifornia | $428.83 | $287.89 |
| Merced, CACalifornia | $428.83 | $287.89 |
| Modesto, CACalifornia | $428.83 | $287.89 |
| Napa, CACalifornia | $493.79 | $324.31 |
| Oxnard, CACalifornia | $454.76 | $302.76 |
| Redding, CACalifornia | $428.83 | $287.89 |
| Rest of CaliforniaCalifornia | $428.83 | $287.89 |
| Riverside, CACalifornia | $434.14 | $293.21 |
| Sacramento, CACalifornia | $449.21 | $299.65 |
| Salinas, CACalifornia | $447.51 | $298.47 |
| San Diego, CACalifornia | $457.45 | $303.65 |
| Marin County, CACalifornia | $521.69 | $340.38 |
| San Francisco, CACalifornia | $521.14 | $339.82 |
| San Benito County, CACalifornia | $533.41 | $347.98 |
| Santa Clara County, CACalifornia | $531.14 | $345.70 |
| San Luis Obispo, CACalifornia | $440.41 | $293.94 |
| Santa Cruz, CACalifornia | $461.36 | $305.12 |
| Santa Maria, CACalifornia | $449.03 | $299.09 |
| Santa Rosa, CACalifornia | $465.97 | $308.05 |
| Stockton, CACalifornia | $428.83 | $287.89 |
| Vallejo, CACalifornia | $492.99 | $323.51 |
| Visalia, CACalifornia | $428.83 | $287.89 |
| Yuba City, CACalifornia | $428.83 | $287.89 |
| ColoradoColorado | $423.61 | $286.79 |
| ConnecticutConnecticut | $435.12 | $296.62 |
| DelawareDelaware | $404.22 | $277.17 |
| Fort Lauderdale, FLFlorida | $425.22 | $294.95 |
| Rest of FloridaFlorida | $404.88 | $281.94 |
| Atlanta, GAGeorgia | $416.46 | $285.81 |
| Rest of GeorgiaGeorgia | $382.56 | $267.86 |
| Hawaii, Guam, HIHawaii | $438.48 | $292.27 |
| IowaIowa | $375.74 | $258.08 |
| IdahoIdaho | $378.33 | $260.03 |
| East St. Louis, ILIllinois | $403.55 | $285.25 |
| Rest of IllinoisIllinois | $394.29 | $276.88 |
| Suburban Chicago, ILIllinois | $429.26 | $297.19 |
| IndianaIndiana | $380.43 | $261.22 |
| KansasKansas | $374.53 | $258.28 |
| KentuckyKentucky | $377.22 | $262.90 |
| New Orleans, LALouisiana | $394.84 | $273.83 |
| Rest of LouisianaLouisiana | $376.85 | $263.04 |
| Metropolitan Boston, MAMassachusetts | $463.96 | $310.42 |
| Rest of MassachusettsMassachusetts | $421.41 | $286.00 |
| Baltimore area, MDMaryland | $433.99 | $296.01 |
| Rest of MarylandMaryland | $411.61 | $281.47 |
| Rest of MaineMaine | $380.77 | $262.46 |
| Southern Maine, MEMaine | $400.03 | $272.59 |
| Detroit, MIMichigan | $410.30 | $286.21 |
| Rest of MichiganMichigan | $387.18 | $269.78 |
| MinnesotaMinnesota | $404.78 | $272.46 |
| Metropolitan Kansas City, MOMissouri | $391.69 | $270.95 |
| Metropolitan St. Louis, MOMissouri | $395.60 | $273.18 |
| Rest of MissouriMissouri | $370.92 | $260.07 |
| MississippiMississippi | $366.80 | $256.08 |
| MontanaMontana | $408.46 | $279.87 |
| North CarolinaNorth Carolina | $384.55 | $264.57 |
| North DakotaNorth Dakota | $398.77 | $270.18 |
| NebraskaNebraska | $377.58 | $258.89 |
| New HampshireNew Hampshire | $417.48 | $283.62 |
| Northern New JerseyNew Jersey | $460.42 | $311.25 |
| Rest of New JerseyNew Jersey | $439.76 | $299.34 |
| New MexicoNew Mexico | $389.44 | $271.52 |
| NevadaNevada | $406.03 | $277.31 |
| NYC suburbs and Long Island, NYNew York | $481.27 | $328.37 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $443.04 | $302.23 |
| Queens, NYNew York | $472.59 | $320.59 |
| Rest of New YorkNew York | $390.17 | $268.01 |
| OhioOhio | $385.20 | $267.80 |
| OklahomaOklahoma | $376.04 | $261.20 |
| Portland, OROregon | $436.15 | $293.28 |
| Rest of OregonOregon | $402.56 | $274.48 |
| Metropolitan Philadelphia, PAPennsylvania | $424.90 | $291.04 |
| Rest of PennsylvaniaPennsylvania | $385.52 | $267.47 |
| Puerto RicoPuerto Rico | $411.21 | $281.20 |
| Rhode IslandRhode Island | $417.94 | $285.11 |
| South DakotaSouth Dakota | $397.63 | $269.03 |
| TennesseeTennessee | $376.42 | $259.53 |
| Austin, TXTexas | $422.49 | $286.44 |
| Beaumont, TXTexas | $383.10 | $266.08 |
| Brazoria, TXTexas | $403.45 | $276.02 |
| Dallas, TXTexas | $406.20 | $278.12 |
| Fort Worth, TXTexas | $403.72 | $276.93 |
| Galveston, TXTexas | $404.78 | $277.08 |
| Houston, TXTexas | $413.75 | $286.05 |
| Rest of TexasTexas | $393.18 | $271.14 |
| UtahUtah | $390.67 | $269.79 |
| VirginiaVirginia | $399.10 | $272.70 |
| Virgin Islands, VIUnited States Virgin Islands | $411.21 | $281.20 |
| VermontVermont | $397.72 | $270.41 |
| Rest of WashingtonWashington | $420.45 | $285.04 |
| King County, WAWashington | $472.75 | $314.97 |
| WisconsinWisconsin | $385.86 | $262.67 |
| West VirginiaWest Virginia | $380.28 | $268.53 |
| WyomingWyoming | $404.24 | $275.64 |
40816 rates by state
Office rate range in each state. Select a state to see its payment localities.
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.
$362.60
$481.12
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $480.10 | 1 |
| AL | $367.74 | 1 |
| AR | $362.60 | 1 |
| AZ | $397.79 | 1 |
| CA | $428.83–$533.41 | 29 |
| CO | $423.61 | 1 |
| CT | $435.12 | 1 |
| DC | $464.90 | 1 |
| DE | $404.22 | 1 |
| FL | $404.88–$444.55 | 3 |
| GA | $382.56–$416.46 | 2 |
| GU | $438.48 | 1 |
| HI | $438.48 | 1 |
| IA | $375.74 | 1 |
| ID | $378.33 | 1 |
| IL | $394.29–$431.89 | 4 |
| IN | $380.43 | 1 |
| KS | $374.53 | 1 |
| KY | $377.22 | 1 |
| LA | $376.85–$394.84 | 2 |
| MA | $421.41–$463.96 | 2 |
| MD | $411.61–$464.90 | 3 |
| ME | $380.77–$400.03 | 2 |
| MI | $387.18–$410.30 | 2 |
| MN | $404.78 | 1 |
| MO | $370.92–$395.60 | 3 |
| MS | $366.80 | 1 |
| MT | $408.46 | 1 |
| NC | $384.55 | 1 |
| ND | $398.77 | 1 |
| NE | $377.58 | 1 |
| NH | $417.48 | 1 |
| NJ | $439.76–$460.42 | 2 |
| NM | $389.44 | 1 |
| NV | $406.03 | 1 |
| NY | $390.17–$481.27 | 5 |
| OH | $385.20 | 1 |
| OK | $376.04 | 1 |
| OR | $402.56–$436.15 | 2 |
| PA | $385.52–$424.90 | 2 |
| PR | $411.21 | 1 |
| RI | $417.94 | 1 |
| SC | $385.58 | 1 |
| SD | $397.63 | 1 |
| TN | $376.42 | 1 |
| TX | $383.10–$422.49 | 8 |
| UT | $390.67 | 1 |
| VA | $399.10–$464.90 | 2 |
| VI | $411.21 | 1 |
| VT | $397.72 | 1 |
| WA | $420.45–$472.75 | 2 |
| WI | $385.86 | 1 |
| WV | $380.28 | 1 |
| WY | $404.24 | 1 |
How the 40816 rate is calculated
Each of 40816’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 · 40816
RVUs × geographic indexes × conversion factor
Work3.68
3.68 RVUs× 1.000 GPCI
Practice expense8.06
8.06 RVUs× 1.000 GPCI
Malpractice0.49
0.49 RVUs× 1.000 GPCI
Adjusted RVUs
12.2300
Conversion factor
$33.4009
Medicare rate
$408.49
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
4,866
- Code
- 40816
- Physician work
- 3.68
- Practice expense
- 8.06
- Malpractice
- 0.49
GPCI2026.csv
93
- Locality
- South Carolina
- Physician work
- 1.000
- Practice expense
- 0.924
- Malpractice
- 0.850
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.68 | × 1.000 | 3.6800 |
| Practice expense | 8.06 | × 0.924 | 7.4474 |
| Malpractice | 0.49 | × 0.850 | 0.4165 |
| Total RVUs | 11.5439 | ||
| Conversion factor | × 33.4009 | ||
Office rate, South Carolina$385.58
Office: (3.68 × 1 + 8.06 × 0.924 + 0.49 × 0.85) × $33.4009 = $385.58
Facility: (3.68 × 1 + 4.21 × 0.924 + 0.49 × 0.85) × $33.4009 = $266.76
Payment rules and modifiers for 40816
40816 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 40816
Mouth lesion excision, with full-thickness skin graft
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.09/0.81/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 40816
Mouth lesion excision, with full-thickness skin graft
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.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
40816 without 51 · national office
$408.49
Mouth lesion excision, with full-thickness skin graft
40816-51 · Second procedure: 50%
$204.25
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%).
How 40816 has changed in South Carolina
40816 · Office / nonfacility
$385.58
Effective 2026-10-01
The base rate is $18.26 higher than on 2025-10-01, moving from $367.32 to $385.58 (5.0%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
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
January 1, 2026
RVU26A
$367.32changed to$385.58
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 3.77 changed to 3.68
- Practice expense RVU 7.87 changed to 8.06
- Practice expense GPCI 0.913 changed to 0.924
- Malpractice GPCI 0.817 changed to 0.850
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$378.98changed to$367.32
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 7.92 changed to 7.87
- Malpractice RVU 0.47 changed to 0.49
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$372.79changed to$378.98
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$381.49changed to$372.79
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 7.88 changed to 7.92
- Malpractice RVU 0.44 changed to 0.47
- Practice expense GPCI 0.908 changed to 0.913
- Malpractice GPCI 0.756 changed to 0.817
January 1, 2023
RVU23A
$383.37changed to$381.49
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 7.77 changed to 7.88
- Malpractice RVU 0.42 changed to 0.44
- Practice expense GPCI 0.903 changed to 0.908
- Malpractice GPCI 0.695 changed to 0.756
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$383.96changed to$383.37
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 7.68 changed to 7.77
- Malpractice RVU 0.43 changed to 0.42
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$382.96changed to$383.96
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 7.24 changed to 7.68
- Malpractice RVU 0.44 changed to 0.43
- Practice expense GPCI 0.907 changed to 0.903
- Malpractice GPCI 0.624 changed to 0.695
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$383.62changed to$382.96
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 7.18 changed to 7.24
- Malpractice RVU 0.59 changed to 0.44
- Practice expense GPCI 0.912 changed to 0.907
- Malpractice GPCI 0.553 changed to 0.624
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$383.85changed to$383.62
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 7.20 changed to 7.18
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$388.21changed to$383.85
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 7.31 changed to 7.20
- Malpractice RVU 0.60 changed to 0.59
- Malpractice GPCI 0.634 changed to 0.553
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$392.30changed to$388.21
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 7.41 changed to 7.31
- Malpractice GPCI 0.715 changed to 0.634
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$392.34changed to$392.30
- Conversion factor 35.9335 changed to 35.8043
- Practice expense RVU 7.36 changed to 7.41
- Malpractice RVU 0.61 changed to 0.60
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$390.39changed to$392.34
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$388.60changed to$390.39
- Conversion factor 35.8228 changed to 35.7547
- Practice expense RVU 7.43 changed to 7.36
- Malpractice RVU 0.50 changed to 0.61
- Practice expense GPCI 0.911 changed to 0.912
- Malpractice GPCI 0.618 changed to 0.715
Held through RVU15B.
January 1, 2014
RVU14A
$388.28changed to$388.60
- Conversion factor 34.0230 changed to 35.8228
- Practice expense RVU 8.11 changed to 7.43
- Malpractice RVU 0.52 changed to 0.50
- Practice expense GPCI 0.909 changed to 0.911
- Malpractice GPCI 0.520 changed to 0.618
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $388.28
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $385.58 | $266.76 | RVU26D |
| 2026-07-01 | $385.58 | $266.76 | RVU26C |
| 2026-04-01 | $385.58 | $266.76 | RVU26B |
| 2026-01-01 | $385.58 | $266.76 | RVU26A |
| 2025-10-01 | $367.32 | $281.67 | RVU25D |
| 2025-07-01 | $367.32 | $281.67 | RVU25C |
| 2025-04-01 | $367.32 | $281.67 | RVU25B |
| 2025-01-01 | $367.32 | $281.67 | RVU25A |
| 2024-10-01 | $378.98 | $288.11 | RVU24D |
| 2024-07-01 | $378.98 | $288.11 | RVU24C |
| 2024-04-01 | $378.98 | $288.11 | RVU24B |
| 2024-03-09 | $378.98 | $288.11 | RVU24AR |
| 2024-01-01 | $372.79 | $283.40 | RVU24A |
| 2023-10-01 | $381.49 | $288.57 | RVU23D |
| 2023-07-01 | $381.49 | $288.57 | RVU23C |
| 2023-04-01 | $381.49 | $288.57 | RVU23B |
| 2023-01-01 | $381.49 | $288.57 | RVU23A |
| 2022-10-01 | $383.37 | $288.38 | RVU22D |
| 2022-07-01 | $383.37 | $288.38 | RVU22C |
| 2022-04-01 | $383.37 | $288.38 | RVU22B |
| 2022-01-01 | $383.37 | $288.38 | RVU22A |
| 2021-10-01 | $383.96 | $289.12 | RVU21D |
| 2021-07-01 | $383.96 | $289.12 | RVU21C |
| 2021-04-01 | $383.96 | $289.12 | RVU21B |
| 2021-01-01 | $383.96 | $289.12 | RVU21A |
| 2020-10-01 | $382.96 | $296.54 | RVU20D |
| 2020-07-01 | $382.96 | $296.54 | RVU20C |
| 2020-04-01 | $382.96 | $296.54 | RVU20B |
| 2020-01-01 | $382.96 | $296.54 | RVU20A |
| 2019-10-01 | $383.62 | $300.79 | RVU19D |
| 2019-07-01 | $383.62 | $300.79 | RVU19C |
| 2019-04-01 | $383.62 | $300.79 | RVU19B |
| 2019-01-01 | $383.62 | $300.79 | RVU19A |
| 2018-10-01 | $383.85 | $304.07 | RVU18D |
| 2018-07-01 | $383.85 | $304.07 | RVU18C |
| 2018-04-01 | $383.85 | $304.07 | RVU18B |
| 2018-01-01 | $383.85 | $304.07 | RVU18AR1 |
| 2017-10-01 | $388.21 | $308.68 | RVU17D |
| 2017-07-01 | $388.21 | $308.68 | RVU17C |
| 2017-04-01 | $388.21 | $308.68 | RVU17B |
| 2017-01-01 | $388.21 | $308.68 | RVU17A |
| 2016-10-01 | $392.30 | $312.30 | RVU16D |
| 2016-07-01 | $392.30 | $312.30 | RVU16C |
| 2016-04-01 | $392.30 | $312.30 | RVU16B |
| 2016-01-01 | $392.30 | $312.30 | RVU16A |
| 2015-10-01 | $392.34 | $312.05 | RVU15D |
| 2015-07-01 | $392.34 | $312.05 | RVU15C |
| 2015-04-01 | $390.39 | $310.50 | RVU15B |
| 2015-01-01 | $390.39 | $310.50 | RVU15A |
| 2014-10-01 | $388.60 | $309.29 | RVU14D |
| 2014-07-01 | $388.60 | $309.29 | RVU14C |
| 2014-04-01 | $388.60 | $309.29 | RVU14B |
| 2014-01-01 | $388.60 | $309.29 | RVU14A |
| 2013-10-01 | $388.28 | $304.78 | RVU13D |
| 2013-07-01 | $388.28 | $304.78 | RVU13C |
| 2013-04-01 | $388.28 | $304.78 | RVU13B |
| 2013-01-01 | $388.28 | $304.78 | RVU13AR |
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
40816 billing questions
How does 40816 differ from 40810, 40812, and 40814?
40816 describes lesion excision with full-thickness skin graft closure. The neighboring codes distinguish excision without repair or with simple or complex repair; the operative documentation should support the closure method reported.
Is a biopsy code appropriate when the lesion is removed?
40808 describes biopsy of a vestibular mouth lesion. When the lesion is excised and the defect is reconstructed with a full-thickness skin graft, report the excision service rather than treating the work as biopsy alone.
What documentation supports reporting 40816?
Document the oral vestibule site, lesion excision, resulting defect, and use of a full-thickness skin graft for closure.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can modifier 50 or an assistant-at-surgery claim be used?
Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery for this service.
How are other procedures in the same session affected?
Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%. 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
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