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CPT code 40816: Mouth lesion excision, with full-thickness skin graft2026 Medicare rate & RVUs in Virginia

Excision of a vestibular mouth lesion followed by full-thickness skin graft closure, reported when the defect requires graft reconstruction rather than routine repair.

CMS RVU26DEffective Oct 1, 2026One payment locality522 Medicare services in 2024

In Virginia, Medicare pays $399.10 for 40816 in the office and $272.70 when it’s performed in a hospital or facility.

$399.10Office (non-facility)
$272.70Hospital or facility
−2.3%vs the national office rate ($408.49)

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.

We’ll open 40816 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Virginia
  2. What 40816 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 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 Virginia 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. Virginia pays $399.10. The RVUs are the same everywhere; the geographic indexes change the dollars.

40816 in Virginia vs other payment areas
  1. Virginia · this page$399.10
  2. Los Angeles, CA · California$457.30+$58.20
  3. Washington, DC area · District of Columbia$464.90+$65.80
  4. Miami, FL · Florida$444.55+$45.45
  5. Chicago, IL · Illinois$431.89+$32.79
  6. Manhattan, NY · New York$469.56+$70.46
  7. Alaska · Alaska$480.10+$81.00

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

Every other payment area

40816 in every other Medicare payment locality
Payment localityOfficeFacility
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

40816 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.

$362.60

$481.12

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

View every state and territory as a table
40816 office rate range by state
State / territoryOffice rate rangeLocalities
AK$480.101
AL$367.741
AR$362.601
AZ$397.791
CA$428.83–$533.4129
CO$423.611
CT$435.121
DC$464.901
DE$404.221
FL$404.88–$444.553
GA$382.56–$416.462
GU$438.481
HI$438.481
IA$375.741
ID$378.331
IL$394.29–$431.894
IN$380.431
KS$374.531
KY$377.221
LA$376.85–$394.842
MA$421.41–$463.962
MD$411.61–$464.903
ME$380.77–$400.032
MI$387.18–$410.302
MN$404.781
MO$370.92–$395.603
MS$366.801
MT$408.461
NC$384.551
ND$398.771
NE$377.581
NH$417.481
NJ$439.76–$460.422
NM$389.441
NV$406.031
NY$390.17–$481.275
OH$385.201
OK$376.041
OR$402.56–$436.152
PA$385.52–$424.902
PR$411.211
RI$417.941
SC$385.581
SD$397.631
TN$376.421
TX$383.10–$422.498
UT$390.671
VA$399.10–$464.902
VI$411.211
VT$397.721
WA$420.45–$472.752
WI$385.861
WV$380.281
WY$404.241

See 40816 in every payment locality

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

Office or facility?

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 Virginia 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

106

Locality
Virginia
Physician work
1.000
Practice expense
0.983
Malpractice
0.706
Office calculation for 40816 in Virginia
ComponentRVULocality factorAdjusted
Physician work3.68× 1.0003.6800
Practice expense8.06× 0.9837.9230
Malpractice0.49× 0.7060.3459
Total RVUs11.9489
Conversion factor× 33.4009

Office rate, Virginia$399.10

Office: (3.68 × 1 + 8.06 × 0.983 + 0.49 × 0.706) × $33.4009 = $399.10

Facility: (3.68 × 1 + 4.21 × 0.983 + 0.49 × 0.706) × $33.4009 = $272.70

Open 40816 in the RVU calculator

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

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 · 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.

  • 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

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%).

When to use modifier 51

Codes related to 40816

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

Codes related to 40816
CodeHow it relatesOffice range, Virginia
Same family
40810Mouth lesion excision, without repairVestibular lesion excision without repair.$211.52
40812Oral lesion excision, simple repairVestibular lesion excision with simple repair.$275.08
40814Oral lesion excision, complex repairVestibular lesion excision with complex repair.$373.49
Used instead
40808Mouth biopsy, oral vestibuleBiopsy of a vestibular mouth lesion rather than excision with graft closure.$164.43
40818Oral graft harvest, vestibular mucosaExcision of vestibular mucosa as a donor graft, rather than lesion excision with skin graft closure.$356.54

How 40816 has changed in Virginia

40816 · Office / nonfacility

$399.10

Effective 2026-10-01

The base rate is $14.45 higher than on 2025-10-01, moving from $384.65 to $399.10 (3.8%).

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

    $384.65changed to$399.10

    • 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
    • Work GPCI 1.002 changed to 1.000
    • Practice expense GPCI 0.984 changed to 0.983
    • Malpractice GPCI 0.755 changed to 0.706

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $396.98changed to$384.65

    • 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.

  3. March 9, 2024

    RVU24AR

    $390.50changed to$396.98

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $404.43changed to$390.50

    • 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
    • Work GPCI 1.000 changed to 1.002
    • Practice expense GPCI 0.990 changed to 0.984
    • Malpractice GPCI 0.826 changed to 0.755

  5. January 1, 2023

    RVU23A

    $411.05changed to$404.43

    • 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 0.995 changed to 0.990
    • Malpractice GPCI 0.897 changed to 0.826

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $411.64changed to$411.05

    • 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.

  7. January 1, 2021

    RVU21A

    $409.33changed to$411.64

    • 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 0.991 changed to 0.995
    • Malpractice GPCI 0.903 changed to 0.897

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $410.31changed to$409.33

    • 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 0.986 changed to 0.991
    • Malpractice GPCI 0.908 changed to 0.903

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $410.57changed to$410.31

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 7.20 changed to 7.18

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $412.36changed to$410.57

    • 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
    • Practice expense GPCI 0.985 changed to 0.986
    • Malpractice GPCI 0.866 changed to 0.908

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $413.48changed to$412.36

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 7.41 changed to 7.31
    • Practice expense GPCI 0.983 changed to 0.985
    • Malpractice GPCI 0.824 changed to 0.866

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $413.51changed to$413.48

    • 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.

  13. July 1, 2015

    RVU15C

    $411.45changed to$413.51

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $409.83changed to$411.45

    • 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 0.980 changed to 0.983
    • Malpractice GPCI 0.778 changed to 0.824

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $410.78changed to$409.83

    • 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 0.977 changed to 0.980
    • Malpractice GPCI 0.731 changed to 0.778

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $410.78

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$399.10$272.70RVU26D
2026-07-01$399.10$272.70RVU26C
2026-04-01$399.10$272.70RVU26B
2026-01-01$399.10$272.70RVU26A
2025-10-01$384.65$292.35RVU25D
2025-07-01$384.65$292.35RVU25C
2025-04-01$384.65$292.35RVU25B
2025-01-01$384.65$292.35RVU25A
2024-10-01$396.98$299.04RVU24D
2024-07-01$396.98$299.04RVU24C
2024-04-01$396.98$299.04RVU24B
2024-03-09$396.98$299.04RVU24AR
2024-01-01$390.50$294.16RVU24A
2023-10-01$404.43$303.12RVU23D
2023-07-01$404.43$303.12RVU23C
2023-04-01$404.43$303.12RVU23B
2023-01-01$404.43$303.12RVU23A
2022-10-01$411.05$306.37RVU22D
2022-07-01$411.05$306.37RVU22C
2022-04-01$411.05$306.37RVU22B
2022-01-01$411.05$306.37RVU22A
2021-10-01$411.64$307.14RVU21D
2021-07-01$411.64$307.14RVU21C
2021-04-01$411.64$307.14RVU21B
2021-01-01$411.64$307.14RVU21A
2020-10-01$409.33$314.91RVU20D
2020-07-01$409.33$314.91RVU20C
2020-04-01$409.33$314.91RVU20B
2020-01-01$409.33$314.91RVU20A
2019-10-01$410.31$320.77RVU19D
2019-07-01$410.31$320.77RVU19C
2019-04-01$410.31$320.77RVU19B
2019-01-01$410.31$320.77RVU19A
2018-10-01$410.57$324.32RVU18D
2018-07-01$410.57$324.32RVU18C
2018-04-01$410.57$324.32RVU18B
2018-01-01$410.57$324.32RVU18AR1
2017-10-01$412.36$326.46RVU17D
2017-07-01$412.36$326.46RVU17C
2017-04-01$412.36$326.46RVU17B
2017-01-01$412.36$326.46RVU17A
2016-10-01$413.48$327.25RVU16D
2016-07-01$413.48$327.25RVU16C
2016-04-01$413.48$327.25RVU16B
2016-01-01$413.48$327.25RVU16A
2015-10-01$413.51$326.97RVU15D
2015-07-01$413.51$326.97RVU15C
2015-04-01$411.45$325.34RVU15B
2015-01-01$411.45$325.34RVU15A
2014-10-01$409.83$324.52RVU14D
2014-07-01$409.83$324.52RVU14C
2014-04-01$409.83$324.52RVU14B
2014-01-01$409.83$324.52RVU14A
2013-10-01$410.78$321.03RVU13D
2013-07-01$410.78$321.03RVU13C
2013-04-01$410.78$321.03RVU13B
2013-01-01$410.78$321.03RVU13AR

Price 40816 for an earlier date of service

Where the Virginia rate applies

Virginia is a Medicare payment area, not a city. Our Census mapping connects it to 628 cities and communities in Virginia. Some span more than one payment area; confirm with the service ZIP.

  • Abbs Valley
  • Abingdon
  • Accomac
  • Adwolf
  • Afton
  • Alberta
  • Aldie
  • Allison Gap

Browse all communities in Virginia

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
RVUs for 40816PPRRVU2026_Oct_nonQPP.csv, line 4,866 (RVU26D)
Geographic factors for VirginiaGPCI2026.csv, line 106 (RVU26D)

Open CMS sourceHow we calculate rates

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