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CPT code 40820: Oral lesion treatment, without repair2026 Medicare rate & RVUs in Fort Worth, TX

Report this service when a clinician treats a mucosal lesion in the vestibule of the mouth without repairing the treated area.

CMS RVU26DEffective Oct 1, 2026One payment locality1.8K Medicare services in 2024

In Fort Worth, TX, Medicare pays $249.08 for 40820 in the office and $151.59 when it’s performed in a hospital or facility.

$249.08Office (non-facility)
$151.59Hospital or facility
−1.2%vs the national office rate ($252.18)

Check a contract rate as a % of Medicare · 40820 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 40820 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Fort Worth, TX
  2. What 40820 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 40820 covers

This service covers direct treatment of a lesion on the vestibular lining of the mouth—the inner lip or cheek area facing the teeth and gums—when the treatment does not include repair. Oral and maxillofacial surgeons, otolaryngologists, and other clinicians performing oral procedures may provide it in an office or facility. The key distinction is that the lesion is treated in place, rather than sampled for diagnosis or removed by excision.

The record should identify the lesion’s location and nature, describe the treatment performed, and support that no repair was performed. Choose a biopsy code when tissue is sampled for diagnosis, or an excision code when the lesion is cut out. This minor procedure has a 10-day global period, so related postoperative visits during that period are included. When multiple procedures are performed 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 service. Medicare does not pay an assistant at surgery, and 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 Fort Worth, TX compares for 40820

Across 109 of 109 payment localities, the office rate for 40820 runs from $221.07 in Arkansas to $344.57 in San Benito County, CA. Fort Worth, TX pays $249.08. The RVUs are the same everywhere; the geographic indexes change the dollars.

40820 in Fort Worth, TX vs other payment areas
  1. Fort Worth, TX · this page$249.08
  2. Austin, TX · Texas$263.49+$14.41
  3. Beaumont, TX · Texas$233.51−$15.57
  4. Brazoria, TX · Texas$249.59+$0.51
  5. Dallas, TX · Texas$251.05+$1.97
  6. Galveston, TX · Texas$250.24+$1.16
  7. Houston, TX · Texas$252.99+$3.91

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

Every other payment area

40820 in every other Medicare payment locality
Payment localityOfficeFacility
Rest of TexasTexas$241.32$147.49
Los Angeles, CACalifornia$289.51$172.55
Washington, DC areaDistrict of Columbia$291.31$174.85
Miami, FLFlorida$268.18$165.26
Chicago, ILIllinois$259.99$160.63
Manhattan, NYNew York$290.87$175.98
AlaskaAlaska$285.03$179.73
AlabamaAlabama$224.58$138.07

40820 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.

$221.07

$307.35

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

View every state and territory as a table
40820 office rate range by state
State / territoryOffice rate rangeLocalities
AK$285.031
AL$224.581
AR$221.071
AZ$245.151
CA$270.12–$344.5729
CO$264.621
CT$269.771
DC$291.311
DE$249.451
FL$245.75–$268.183
GA$231.17–$256.572
GU$277.931
HI$277.931
IA$231.871
ID$233.261
IL$237.30–$261.844
IN$234.751
KS$230.161
KY$229.171
LA$228.57–$240.862
MA$262.64–$292.882
MD$254.64–$291.313
ME$234.01–$248.502
MI$235.13–$248.492
MN$254.551
MO$223.98–$242.423
MS$222.591
MT$252.171
NC$236.741
ND$249.201
NE$233.401
NH$259.891
NJ$273.13–$287.822
NM$236.301
NV$251.541
NY$240.52–$297.725
OH$234.521
OK$229.291
OR$249.88–$274.172
PA$235.22–$262.272
PR$254.341
RI$259.181
SC$235.971
SD$248.851
TN$231.351
TX$233.51–$263.498
UT$239.461
VA$247.25–$291.312
VI$254.341
VT$247.671
WA$262.33–$299.622
WI$240.171
WV$227.691
WY$250.871

See 40820 in every payment locality

How the 40820 rate is calculated

Each of 40820’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 · 40820

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.31

1.31 RVUs× 1.000 GPCI

Practice expense6.09

6.09 RVUs× 1.000 GPCI

Malpractice0.15

0.15 RVUs× 1.000 GPCI

Adjusted RVUs

7.5500

Conversion factor

$33.4009

Medicare rate

$252.18

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

The exact Fort Worth, TX inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

4,869

Code
40820
Physician work
1.31
Practice expense
6.09
Malpractice
0.15

GPCI2026.csv

100

Locality
Fort Worth, TX
Physician work
1.009
Practice expense
0.986
Malpractice
0.871
Office calculation for 40820 in Fort Worth, TX
ComponentRVULocality factorAdjusted
Physician work1.31× 1.0091.3218
Practice expense6.09× 0.9866.0047
Malpractice0.15× 0.8710.1306
Total RVUs7.4572
Conversion factor× 33.4009

Office rate, Fort Worth, TX$249.08

Office: (1.31 × 1.009 + 6.09 × 0.986 + 0.15 × 0.871) × $33.4009 = $249.08

Facility: (1.31 × 1.009 + 3.13 × 0.986 + 0.15 × 0.871) × $33.4009 = $151.59

Open 40820 in the RVU calculator

Payment rules and modifiers for 40820

40820 has a 10-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 40820

Oral lesion treatment, without repair

RuleCMS valueWhat it means
Global period010Minor procedure: the day of the procedure plus 10 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)0.10/0.80/0.10Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 40820

Oral lesion treatment, without repair

10-day global period ends

Oct 11, 2026

Covers Oct 1, 2026 through Oct 11, 2026 (11 days).

Visit on Oct 31, 2026

After the global period ends: visits and procedures are billed normally.

SurgeryVisit
Sep 28, 2026Oct 14, 2026

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

40820 without 51 · national office

$252.18

Oral lesion treatment, without repair

40820-51 · Second procedure: 50%

$126.09

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 40820

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

Codes related to 40820
CodeHow it relatesOffice range, Fort Worth, TX
Used instead
40810Mouth lesion excision, without repairUse when the vestibular lesion is excised rather than treated in place.$213.41
40812Oral lesion excision, simple repairFor excision of a vestibular lesion with repair, rather than treatment without repair.$277.96
40808Mouth biopsy, oral vestibuleFor diagnostic biopsy of a mouth lesion when tissue sampling, not treatment, is performed.$165.90

How 40820 has changed in Fort Worth, TX

40820 · Office / nonfacility

$249.08

Effective 2026-10-01

The base rate is $2.67 higher than on 2025-10-01, moving from $246.41 to $249.08 (1.1%).

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

    $246.41changed to$249.08

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.34 changed to 1.31
    • Practice expense RVU 6.14 changed to 6.09
    • Work GPCI 1.011 changed to 1.009
    • Practice expense GPCI 0.998 changed to 0.986
    • Malpractice GPCI 0.902 changed to 0.871

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $258.92changed to$246.41

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 6.31 changed to 6.14
    • Malpractice RVU 0.14 changed to 0.15

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $254.70changed to$258.92

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $262.39changed to$254.70

    • Conversion factor 33.8872 changed to 32.7442
    • Work GPCI 1.013 changed to 1.011
    • Practice expense GPCI 0.996 changed to 0.998
    • Malpractice GPCI 0.721 changed to 0.902

  5. January 1, 2023

    RVU23A

    $271.10changed to$262.39

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 6.44 changed to 6.31
    • Malpractice RVU 0.12 changed to 0.14
    • Work GPCI 1.016 changed to 1.013
    • Practice expense GPCI 0.995 changed to 0.996
    • Malpractice GPCI 0.539 changed to 0.721

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $274.77changed to$271.10

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 6.47 changed to 6.44
    • Malpractice RVU 0.14 changed to 0.12

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $264.71changed to$274.77

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 5.95 changed to 6.47
    • Malpractice RVU 0.13 changed to 0.14
    • Work GPCI 1.011 changed to 1.016
    • Practice expense GPCI 0.991 changed to 0.995
    • Malpractice GPCI 0.643 changed to 0.539

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $267.14changed to$264.71

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 5.99 changed to 5.95
    • Malpractice RVU 0.21 changed to 0.13
    • Work GPCI 1.007 changed to 1.011
    • Practice expense GPCI 0.986 changed to 0.991
    • Malpractice GPCI 0.747 changed to 0.643

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $268.97changed to$267.14

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 6.05 changed to 5.99

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $272.48changed to$268.97

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 6.14 changed to 6.05
    • Work GPCI 1.006 changed to 1.007
    • Practice expense GPCI 0.991 changed to 0.986
    • Malpractice GPCI 0.760 changed to 0.747

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $274.98changed to$272.48

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 6.21 changed to 6.14
    • Malpractice RVU 0.20 changed to 0.21
    • Work GPCI 1.005 changed to 1.006
    • Practice expense GPCI 0.995 changed to 0.991
    • Malpractice GPCI 0.772 changed to 0.760

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $275.69changed to$274.98

    • Conversion factor 35.9335 changed to 35.8043
    • Malpractice RVU 0.19 changed to 0.20

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $274.32changed to$275.69

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $270.06changed to$274.32

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 6.14 changed to 6.21
    • Malpractice RVU 0.17 changed to 0.19
    • Work GPCI 1.002 changed to 1.005
    • Practice expense GPCI 0.987 changed to 0.995
    • Malpractice GPCI 0.799 changed to 0.772

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $279.15changed to$270.06

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 6.86 changed to 6.14
    • Malpractice RVU 0.18 changed to 0.17
    • Work GPCI 1.000 changed to 1.002
    • Practice expense GPCI 0.979 changed to 0.987
    • Malpractice GPCI 0.826 changed to 0.799

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $279.15

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$249.08$151.59RVU26D
2026-07-01$249.08$151.59RVU26C
2026-04-01$249.08$151.59RVU26B
2026-01-01$249.08$151.59RVU26A
2025-10-01$246.41$160.54RVU25D
2025-07-01$246.41$160.54RVU25C
2025-04-01$246.41$160.54RVU25B
2025-01-01$246.41$160.54RVU25A
2024-10-01$258.92$166.57RVU24D
2024-07-01$258.92$166.57RVU24C
2024-04-01$258.92$166.57RVU24B
2024-03-09$258.92$166.57RVU24AR
2024-01-01$254.70$163.85RVU24A
2023-10-01$262.39$167.55RVU23D
2023-07-01$262.39$167.55RVU23C
2023-04-01$262.39$167.55RVU23B
2023-01-01$262.39$167.55RVU23A
2022-10-01$271.10$171.25RVU22D
2022-07-01$271.10$171.25RVU22C
2022-04-01$271.10$171.25RVU22B
2022-01-01$271.10$171.25RVU22A
2021-10-01$274.77$173.04RVU21D
2021-07-01$274.77$173.04RVU21C
2021-04-01$274.77$173.04RVU21B
2021-01-01$274.77$173.04RVU21A
2020-10-01$264.71$170.29RVU20D
2020-07-01$264.71$170.29RVU20C
2020-04-01$264.71$170.29RVU20B
2020-01-01$264.71$170.29RVU20A
2019-10-01$267.14$173.68RVU19D
2019-07-01$267.14$173.68RVU19C
2019-04-01$267.14$173.68RVU19B
2019-01-01$267.14$173.68RVU19A
2018-10-01$268.97$175.62RVU18D
2018-07-01$268.97$175.62RVU18C
2018-04-01$268.97$175.62RVU18B
2018-01-01$268.97$175.62RVU18AR1
2017-10-01$272.48$178.23RVU17D
2017-07-01$272.48$178.23RVU17C
2017-04-01$272.48$178.23RVU17B
2017-01-01$272.48$178.23RVU17A
2016-10-01$274.98$179.15RVU16D
2016-07-01$274.98$179.15RVU16C
2016-04-01$274.98$179.15RVU16B
2016-01-01$274.98$179.15RVU16A
2015-10-01$275.69$179.16RVU15D
2015-07-01$275.69$179.16RVU15C
2015-04-01$274.32$178.27RVU15B
2015-01-01$274.32$178.27RVU15A
2014-10-01$270.06$176.36RVU14D
2014-07-01$270.06$176.36RVU14C
2014-04-01$270.06$176.36RVU14B
2014-01-01$270.06$176.36RVU14A
2013-10-01$279.15$179.89RVU13D
2013-07-01$279.15$179.89RVU13C
2013-04-01$279.15$179.89RVU13B
2013-01-01$279.15$179.89RVU13AR

Price 40820 for an earlier date of service

Where the Fort Worth, TX rate applies

Fort Worth, TX is a Medicare payment area, not a city. Our Census mapping connects it to 45 cities and communities in Texas. Some span more than one payment area; confirm with the service ZIP.

Browse all communities in Texas

40820 billing questions

How is 40820 different from a biopsy or excision?

Use 40820 when the clinician treats the lesion without taking a diagnostic sample or cutting the lesion out. Report a biopsy when tissue is sampled for diagnosis and an excision code when the lesion is removed.

What documentation supports 40820?

Document the lesion’s location in the vestibule, its relevant clinical characteristics, the treatment performed, and that the treated area was not repaired.

Can 40820 be billed with a repair code?

This code describes treatment without repair. If the service includes repair, review the code for treatment with repair rather than reporting 40820 for the same work.

What postoperative care is included?

Related postoperative visits for 10 days are included in the minor-procedure global period.

Can an assistant or co-surgeon be billed?

Medicare does not pay an assistant at surgery for this service. Co-surgeons and team surgery are not permitted.

How are other procedures in the same session paid?

The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate for 40820.

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 40820PPRRVU2026_Oct_nonQPP.csv, line 4,869 (RVU26D)
Geographic factors for Fort Worth, TXGPCI2026.csv, line 100 (RVU26D)

Open CMS sourceHow we calculate rates

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