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CPT code 40818: Oral graft harvest, vestibular mucosa2026 Medicare rate & RVUs in North Dakota

Reports harvesting oral mucosa from the mouth vestibule for use as a graft during reconstructive surgery, such as urethral reconstruction.

CMS RVU26DEffective Oct 1, 2026One payment locality142 Medicare services in 2024

In North Dakota, Medicare pays $357.46 for 40818 in the office and $239.55 when it’s performed in a hospital or facility.

$357.46Office (non-facility)
$239.55Hospital or facility
−1.9%vs the national office rate ($364.40)

Check a contract rate as a % of Medicare · 40818 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 40818 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in North Dakota
  2. What 40818 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 40818 covers

This service removes oral mucosa from the vestibule of the mouth to provide donor tissue for reconstruction at another site. It is performed by a surgeon, often an oral and maxillofacial surgeon, otolaryngologist, or urologist, when a reconstructive procedure calls for oral mucosal graft tissue. A familiar clinical use is harvesting buccal mucosa for urethral reconstruction. The code represents the donor-site harvest, not removal of a mouth lesion or the reconstruction at the recipient site.

Report the harvest when the operative note identifies the oral donor site, the tissue obtained, and its graft purpose; report the recipient-site procedure separately when performed and supported. CMS 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 for this code. Assistant-at-surgery payment requires documented medical necessity; co-surgeon and team-surgery billing 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 North Dakota compares for 40818

Across 109 of 109 payment localities, the office rate for 40818 runs from $322.00 in Arkansas to $484.27 in San Benito County, CA. North Dakota pays $357.46. The RVUs are the same everywhere; the geographic indexes change the dollars.

40818 in North Dakota vs other payment areas
  1. North Dakota · this page$357.46
  2. Los Angeles, CA · California$411.93+$54.47
  3. Washington, DC area · District of Columbia$417.08+$59.62
  4. Miami, FL · Florida$392.96+$35.50
  5. Chicago, IL · Illinois$381.49+$24.03
  6. Manhattan, NY · New York$419.36+$61.90
  7. Alaska · Alaska$422.18+$64.72

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

Every other payment area

40818 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$326.76$223.60
ArkansasArkansas$322.00$220.72
ArizonaArizona$354.64$240.39
Bakersfield, CACalifornia$386.60$257.37
Chico, CACalifornia$385.56$256.33
El Centro, CACalifornia$385.62$256.39
Fresno, CACalifornia$385.56$256.33
Hanford, CACalifornia$385.56$256.33

40818 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.

$322.00

$434.91

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

View every state and territory as a table
40818 office rate range by state
State / territoryOffice rate rangeLocalities
AK$422.181
AL$326.761
AR$322.001
AZ$354.641
CA$385.56–$484.2729
CO$379.621
CT$388.761
DC$417.081
DE$360.561
FL$358.82–$392.963
GA$338.51–$371.202
GU$395.171
HI$395.171
IA$335.211
ID$337.401
IL$348.32–$381.494
IN$339.381
KS$333.591
KY$334.491
LA$333.95–$350.622
MA$377.31–$417.442
MD$367.49–$417.083
ME$339.14–$357.752
MI$343.25–$363.302
MN$363.731
MO$328.15–$351.923
MS$325.141
MT$364.381
NC$342.731
ND$357.461
NE$337.071
NH$373.621
NJ$393.19–$412.692
NM$345.131
NV$362.711
NY$347.91–$429.565
OH$341.831
OK$333.921
OR$359.89–$391.802
PA$342.40–$379.002
PR$367.091
RI$373.491
SC$342.851
SD$356.641
TN$335.281
TX$340.13–$378.378
UT$347.581
VA$356.54–$417.082
VI$367.091
VT$356.021
WA$376.62–$426.012
WI$345.371
WV$335.311
WY$361.361

See 40818 in every payment locality

How the 40818 rate is calculated

Each of 40818’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 · 40818

RVUs × geographic indexes × conversion factor

Office or facility?

Work2.76

2.76 RVUs× 1.000 GPCI

Practice expense7.80

7.80 RVUs× 1.000 GPCI

Malpractice0.35

0.35 RVUs× 1.000 GPCI

Adjusted RVUs

10.9100

Conversion factor

$33.4009

Medicare rate

$364.40

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact North Dakota inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

4,867

Code
40818
Physician work
2.76
Practice expense
7.80
Malpractice
0.35

GPCI2026.csv

84

Locality
North Dakota
Physician work
1.000
Practice expense
1.000
Malpractice
0.406
Office calculation for 40818 in North Dakota
ComponentRVULocality factorAdjusted
Physician work2.76× 1.0002.7600
Practice expense7.80× 1.0007.8000
Malpractice0.35× 0.4060.1421
Total RVUs10.7021
Conversion factor× 33.4009

Office rate, North Dakota$357.46

Office: (2.76 × 1 + 7.8 × 1 + 0.35 × 0.406) × $33.4009 = $357.46

Facility: (2.76 × 1 + 4.27 × 1 + 0.35 × 0.406) × $33.4009 = $239.55

Open 40818 in the RVU calculator

Payment rules and modifiers for 40818

40818 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 40818

Oral graft harvest, vestibular mucosa

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)0Not paid without supporting documentation.
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 · 40818

Oral graft harvest, vestibular mucosa

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

40818 without 51 · national office

$364.40

Oral graft harvest, vestibular mucosa

40818-51 · Second procedure: 50%

$182.20

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 40818

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

Codes related to 40818
CodeHow it relatesOffice range, North Dakota
Often billed with
53410Urethral reconstruction, male anterior, one-stageMay accompany one-stage anterior urethral reconstruction when oral mucosa is harvested as graft tissue.No office rate
53415Urethroplasty, one-stage, transpubic or perinealMay accompany staged urethral reconstruction when oral mucosa is harvested for the repair.No office rate
Same family
40810Mouth lesion excision, without repairRelated vestibular mucosa surgery, but used for lesion excision rather than graft harvest.$212.53
40812Oral lesion excision, simple repairMouth lesion excision with repair, distinct from harvesting mucosa for grafting.$275.48

How 40818 has changed in North Dakota

40818 · Office / nonfacility

$357.46

Effective 2026-10-01

The base rate is $12.14 higher than on 2025-10-01, moving from $345.32 to $357.46 (3.5%).

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

    $345.32changed to$357.46

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.83 changed to 2.76
    • Practice expense RVU 7.67 changed to 7.80
    • Malpractice RVU 0.34 changed to 0.35
    • Malpractice GPCI 0.517 changed to 0.406

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $358.54changed to$345.32

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 7.76 changed to 7.67
    • Malpractice RVU 0.35 changed to 0.34

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $352.69changed to$358.54

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $368.39changed to$352.69

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 7.88 changed to 7.76
    • Malpractice RVU 0.34 changed to 0.35
    • Malpractice GPCI 0.474 changed to 0.517

  5. January 1, 2023

    RVU23A

    $373.87changed to$368.39

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 7.84 changed to 7.88
    • Malpractice RVU 0.31 changed to 0.34
    • Malpractice GPCI 0.431 changed to 0.474

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $384.65changed to$373.87

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 8.06 changed to 7.84

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $372.64changed to$384.65

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 7.35 changed to 8.06
    • Malpractice RVU 0.30 changed to 0.31
    • Malpractice GPCI 0.485 changed to 0.431

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $372.61changed to$372.64

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 7.32 changed to 7.35
    • Malpractice RVU 0.35 changed to 0.30
    • Malpractice GPCI 0.540 changed to 0.485

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $369.32changed to$372.61

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 7.24 changed to 7.32

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $368.83changed to$369.32

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 7.25 changed to 7.24
    • Malpractice RVU 0.36 changed to 0.35
    • Malpractice GPCI 0.547 changed to 0.540

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $368.05changed to$368.83

    • Conversion factor 35.8043 changed to 35.8887
    • Malpractice GPCI 0.554 changed to 0.547

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $370.81changed to$368.05

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 7.29 changed to 7.25

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $368.97changed to$370.81

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $365.31changed to$368.97

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 7.18 changed to 7.29
    • Malpractice RVU 0.35 changed to 0.36
    • Malpractice GPCI 0.536 changed to 0.554

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $362.73changed to$365.31

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 7.64 changed to 7.18
    • Malpractice RVU 0.37 changed to 0.35
    • Malpractice GPCI 0.517 changed to 0.536

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $362.73

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$357.46$239.55RVU26D
2026-07-01$357.46$239.55RVU26C
2026-04-01$357.46$239.55RVU26B
2026-01-01$357.46$239.55RVU26A
2025-10-01$345.32$253.46RVU25D
2025-07-01$345.32$253.46RVU25C
2025-04-01$345.32$253.46RVU25B
2025-01-01$345.32$253.46RVU25A
2024-10-01$358.54$260.34RVU24D
2024-07-01$358.54$260.34RVU24C
2024-04-01$358.54$260.34RVU24B
2024-03-09$358.54$260.34RVU24AR
2024-01-01$352.69$256.09RVU24A
2023-10-01$368.39$264.70RVU23D
2023-07-01$368.39$264.70RVU23C
2023-04-01$368.39$264.70RVU23B
2023-01-01$368.39$264.70RVU23A
2022-10-01$373.87$266.59RVU22D
2022-07-01$373.87$266.59RVU22C
2022-04-01$373.87$266.59RVU22B
2022-01-01$373.87$266.59RVU22A
2021-10-01$384.65$273.69RVU21D
2021-07-01$384.65$273.69RVU21C
2021-04-01$384.65$273.69RVU21B
2021-01-01$384.65$273.69RVU21A
2020-10-01$372.64$275.20RVU20D
2020-07-01$372.64$275.20RVU20C
2020-04-01$372.64$275.20RVU20B
2020-01-01$372.64$275.20RVU20A
2019-10-01$372.61$279.27RVU19D
2019-07-01$372.61$279.27RVU19C
2019-04-01$372.61$279.27RVU19B
2019-01-01$372.61$279.27RVU19A
2018-10-01$369.32$280.04RVU18D
2018-07-01$369.32$280.04RVU18C
2018-04-01$369.32$280.04RVU18B
2018-01-01$369.32$280.04RVU18AR1
2017-10-01$368.83$280.54RVU17D
2017-07-01$368.83$280.54RVU17C
2017-04-01$368.83$280.54RVU17B
2017-01-01$368.83$280.54RVU17A
2016-10-01$368.05$279.97RVU16D
2016-07-01$368.05$279.97RVU16C
2016-04-01$368.05$279.97RVU16B
2016-01-01$368.05$279.97RVU16A
2015-10-01$370.81$281.34RVU15D
2015-07-01$370.81$281.34RVU15C
2015-04-01$368.97$279.94RVU15B
2015-01-01$368.97$279.94RVU15A
2014-10-01$365.31$278.62RVU14D
2014-07-01$365.31$278.62RVU14C
2014-04-01$365.31$278.62RVU14B
2014-01-01$365.31$278.62RVU14A
2013-10-01$362.73$273.59RVU13D
2013-07-01$362.73$273.59RVU13C
2013-04-01$362.73$273.59RVU13B
2013-01-01$362.73$273.59RVU13AR

Price 40818 for an earlier date of service

Where the North Dakota rate applies

North Dakota is a Medicare payment area, not a city. Our Census mapping connects it to 406 cities and communities in North Dakota. Some span more than one payment area; confirm with the service ZIP.

  • Abercrombie
  • Adams
  • Alamo
  • Alexander
  • Alice
  • Almont
  • Alsen
  • Ambrose

Browse all communities in North Dakota

40818 billing questions

How is graft harvest different from excising a mouth lesion?

This code is for taking oral mucosa as donor tissue for grafting. Lesion-excision codes apply when the purpose is removal of a lesion, with code selection based on the service performed.

Can the recipient-site reconstruction be reported separately?

Yes, when a distinct recipient-site procedure is performed and documented. For example, oral mucosa may be harvested for a urethral reconstruction, with the reconstruction reported under its applicable code.

Does modifier 50 apply when mucosa is harvested from both sides?

No. CMS identifies bilateral adjustment as inappropriate for this code, so modifier 50 should not be used.

What postoperative care is included?

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

When is an assistant at surgery payable?

Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeon and team-surgery billing are not permitted for this code.

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 40818PPRRVU2026_Oct_nonQPP.csv, line 4,867 (RVU26D)
Geographic factors for North DakotaGPCI2026.csv, line 84 (RVU26D)

Open CMS sourceHow we calculate rates

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