Billing code 21040: Mandibular lesion excisionMedicare rate & RVUs

Medicare pays $479.97 for 21040 nationally in the office and $337.68 in a hospital or facility. Local office rates run $428.07–$621.15.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 21040 covers

billing code 21040 describes removal of a benign tumor or cyst from the mandible through an intraoral approach. Oral and maxillofacial surgeons and other surgeons with appropriate training may perform it in an office, ambulatory surgery center, or hospital operating room. The operative work may involve incising oral mucosa, exposing the mandibular lesion, removing it, and closing the site. The code is for a benign lesion, not a malignant jaw tumor or an exostosis.

Select the code based on the documented lesion, mandibular site, and intraoral route; distinguish it from procedures that require osteotomy, address a different jaw, or remove bone for another indication. The operative report should describe the lesion and approach, the removal performed, and any relevant pathology. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery; 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.

Where 21040 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

21040 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 21040 rate is calculated

Each of 21040’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.

Payment rules and modifiers for 21040

21040 has a 90-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 51

21040 compared with similar codes

How to choose

21046Mandibular lesion excision

Use 21040 for intraoral removal of a benign mandibular lesion without the osteotomy specified for 21046. The operative report should establish whether osteotomy was required.

21047Jaw cyst excision

21047 describes benign mandibular lesion removal requiring an extraoral osteotomy. 21040 describes an intraoral approach.

21044Jaw tumor excision

21040 is for a benign mandibular lesion; 21044 is used for the applicable malignant mandibular tumor procedure.

21030Bone lesion excision

Both address benign jaw lesions, but 21030 is for the maxilla and 21040 is for the mandible.

Codes related to 21040

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

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

Open CMS sourceHow we calculate rates