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CMS RVU26D · Effective 2026-10-01

40820 in Austin

Office / nonfacility

$263.49

Base rate per service

Facility setting

$158.89

Base rate per service

Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.

Oral surgery

About 40820: Vestibular oral mucosal lesion treatment

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

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.

CMS billing rules for 40820

Global period
Minor procedure with a 10-day global period: related postoperative visits for 10 days are included.
Multiple procedures
Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
Bilateral procedures
Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
Assistant at surgery
Statutory restriction: assistant at surgery is not paid.
Co-surgeons
Co-surgeons not permitted.
Team surgery
Team surgery not permitted.

Where the value comes from

  • Work RVU1.31 · 17%
  • Practice expense (office) RVU6.09 · 81%
  • Malpractice RVU0.15 · 2%

1.8K

Medicare services in 2024 · #2565 by national volume

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.

40820 compared with similar codes

Office rates for Austin, from the same CMS release.

40808

Mouth biopsy

Oral vestibule

$175.04

40808 is for obtaining tissue to establish a diagnosis. Choose 40820 when the clinician treats the lesion rather than taking a diagnostic sample.

40810

Mouth lesion excision

Without repair

$225.12

40810 describes excision of a vestibular lesion. Use 40820 when the lesion is treated without being excised.

40800

Oral drainage

Simple vestibular drainage

$218.76

40800 is for draining a mouth lesion, such as a fluid collection. 40820 is for treatment of a mucosal lesion, not drainage.

The same code, a different location

How does Austin compare?

In Beaumont, the office rate for 40820 is $233.51—$29.98 lower than the $263.49 rate in Austin. Both use the same code, release and participation basis.

40820 across payment areas

Same release and payment basis · bars start at $0

  1. Austin · This locality

    $263.49

  2. Beaumont

    $233.51

    $29.98 lower than Austin

  3. Brazoria

    $249.59

    $13.90 lower than Austin

  4. Dallas

    $251.05

    $12.44 lower than Austin

  5. Fort Worth

    $249.08

    $14.41 lower than Austin

  6. Galveston

    $250.24

    $13.25 lower than Austin

  7. Houston

    $252.99

    $10.50 lower than Austin

Other payment areas listed in Texas appear first, followed by selected cross-country examples. The chart compares amounts, not distance.

Across 109 of 109 CMS payment localities with a supported office rate, 40820 ranges from $221.07 in Arkansas to $344.57 in San Jose-Sunnyvale-Santa Clara (San Benito Cnty). This is a geographic range, not an average.

The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.

Compare all 108 other payment areas

  • Rest Of Texas

    Texas · 40820

    Office

    $241.32

    Facility

    $147.49

    $22.17 lower than Austin for the office setting.

  • Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty)

    California · 40820

    Office

    $289.51

    Facility

    $172.55

    $26.02 higher than Austin for the office setting.

  • Dc + Md/Va Suburbs

    District of Columbia · 40820

    Office

    $291.31

    Facility

    $174.85

    $27.82 higher than Austin for the office setting.

  • Miami

    Florida · 40820

    Office

    $268.18

    Facility

    $165.26

    $4.69 higher than Austin for the office setting.

  • Chicago

    Illinois · 40820

    Office

    $259.99

    Facility

    $160.63

    $3.50 lower than Austin for the office setting.

  • Manhattan

    New York · 40820

    Office

    $290.87

    Facility

    $175.98

    $27.38 higher than Austin for the office setting.

  • Alaska*

    Alaska · 40820

    Office

    $285.03

    Facility

    $179.73

    $21.54 higher than Austin for the office setting.

  • Alabama

    Alabama · 40820

    Office

    $224.58

    Facility

    $138.07

    $38.91 lower than Austin for the office setting.

  • Arkansas

    Arkansas · 40820

    Office

    $221.07

    Facility

    $136.14

    $42.42 lower than Austin for the office setting.

  • Arizona

    Arizona · 40820

    Office

    $245.15

    Facility

    $149.35

    $18.34 lower than Austin for the office setting.

  • Bakersfield

    California · 40820

    Office

    $270.58

    Facility

    $162.22

    $7.09 higher than Austin for the office setting.

  • Chico

    California · 40820

    Office

    $270.12

    Facility

    $161.77

    $6.63 higher than Austin for the office setting.

  • El Centro

    California · 40820

    Office

    $270.15

    Facility

    $161.79

    $6.66 higher than Austin for the office setting.

  • Fresno

    California · 40820

    Office

    $270.12

    Facility

    $161.77

    $6.63 higher than Austin for the office setting.

  • Hanford-Corcoran

    California · 40820

    Office

    $270.12

    Facility

    $161.77

    $6.63 higher than Austin for the office setting.

  • Madera

    California · 40820

    Office

    $270.12

    Facility

    $161.77

    $6.63 higher than Austin for the office setting.

  • Merced

    California · 40820

    Office

    $270.12

    Facility

    $161.77

    $6.63 higher than Austin for the office setting.

  • Modesto

    California · 40820

    Office

    $270.12

    Facility

    $161.77

    $6.63 higher than Austin for the office setting.

  • Napa

    California · 40820

    Office

    $317.15

    Facility

    $186.85

    $53.66 higher than Austin for the office setting.

  • Oxnard-Thousand Oaks-Ventura

    California · 40820

    Office

    $288.53

    Facility

    $171.67

    $25.04 higher than Austin for the office setting.

  • Redding

    California · 40820

    Office

    $270.12

    Facility

    $161.77

    $6.63 higher than Austin for the office setting.

  • Rest Of California

    California · 40820

    Office

    $270.12

    Facility

    $161.77

    $6.63 higher than Austin for the office setting.

  • Riverside-San Bernardino-Ontario

    California · 40820

    Office

    $271.76

    Facility

    $163.40

    $8.27 higher than Austin for the office setting.

  • Sacramento-Roseville-Folsom

    California · 40820

    Office

    $284.58

    Facility

    $169.60

    $21.09 higher than Austin for the office setting.

  • Salinas

    California · 40820

    Office

    $283.55

    Facility

    $168.96

    $20.06 higher than Austin for the office setting.

  • San Diego-Chula Vista-Carlsbad

    California · 40820

    Office

    $291.06

    Facility

    $172.82

    $27.57 higher than Austin for the office setting.

  • San Francisco-Oakland-Berkeley (Marin Cnty)

    California · 40820

    Office

    $337.02

    Facility

    $197.62

    $73.53 higher than Austin for the office setting.

  • San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)

    California · 40820

    Office

    $336.85

    Facility

    $197.45

    $73.36 higher than Austin for the office setting.

  • San Jose-Sunnyvale-Santa Clara (San Benito Cnty)

    California · 40820

    Office

    $344.57

    Facility

    $202.01

    $81.08 higher than Austin for the office setting.

  • San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)

    California · 40820

    Office

    $343.88

    Facility

    $201.31

    $80.39 higher than Austin for the office setting.

  • San Luis Obispo-Paso Robles

    California · 40820

    Office

    $278.87

    Facility

    $166.26

    $15.38 higher than Austin for the office setting.

  • Santa Cruz-Watsonville

    California · 40820

    Office

    $294.50

    Facility

    $174.38

    $31.01 higher than Austin for the office setting.

  • Santa Maria-Santa Barbara

    California · 40820

    Office

    $284.84

    Facility

    $169.57

    $21.35 higher than Austin for the office setting.

  • Santa Rosa-Petaluma

    California · 40820

    Office

    $297.54

    Facility

    $176.13

    $34.05 higher than Austin for the office setting.

  • Stockton

    California · 40820

    Office

    $270.12

    Facility

    $161.77

    $6.63 higher than Austin for the office setting.

  • Vallejo

    California · 40820

    Office

    $316.91

    Facility

    $186.60

    $53.42 higher than Austin for the office setting.

  • Visalia

    California · 40820

    Office

    $270.12

    Facility

    $161.77

    $6.63 higher than Austin for the office setting.

  • Yuba City

    California · 40820

    Office

    $270.12

    Facility

    $161.77

    $6.63 higher than Austin for the office setting.

  • Colorado

    Colorado · 40820

    Office

    $264.62

    Facility

    $159.43

    $1.13 higher than Austin for the office setting.

  • Connecticut

    Connecticut · 40820

    Office

    $269.77

    Facility

    $163.29

    $6.28 higher than Austin for the office setting.

  • Delaware

    Delaware · 40820

    Office

    $249.45

    Facility

    $151.77

    $14.04 lower than Austin for the office setting.

  • Fort Lauderdale

    Florida · 40820

    Office

    $258.87

    Facility

    $158.72

    $4.62 lower than Austin for the office setting.

  • Rest Of Florida

    Florida · 40820

    Office

    $245.75

    Facility

    $151.23

    $17.74 lower than Austin for the office setting.

  • Atlanta

    Georgia · 40820

    Office

    $256.57

    Facility

    $156.12

    $6.92 lower than Austin for the office setting.

  • Rest Of Georgia

    Georgia · 40820

    Office

    $231.17

    Facility

    $142.98

    $32.32 lower than Austin for the office setting.

  • Hawaii, Guam

    Hawaii · 40820

    Office

    $277.93

    Facility

    $165.52

    $14.44 higher than Austin for the office setting.

  • Iowa

    Iowa · 40820

    Office

    $231.87

    Facility

    $141.40

    $31.62 lower than Austin for the office setting.

  • Idaho

    Idaho · 40820

    Office

    $233.26

    Facility

    $142.31

    $30.23 lower than Austin for the office setting.

  • East St. Louis

    Illinois · 40820

    Office

    $240.98

    Facility

    $150.03

    $22.51 lower than Austin for the office setting.

  • Rest Of Illinois

    Illinois · 40820

    Office

    $237.30

    Facility

    $147.04

    $26.19 lower than Austin for the office setting.

  • Suburban Chicago

    Illinois · 40820

    Office

    $261.84

    Facility

    $160.31

    $1.65 lower than Austin for the office setting.

  • Indiana

    Indiana · 40820

    Office

    $234.75

    Facility

    $143.10

    $28.74 lower than Austin for the office setting.

  • Kansas

    Kansas · 40820

    Office

    $230.16

    Facility

    $140.79

    $33.33 lower than Austin for the office setting.

  • Kentucky

    Kentucky · 40820

    Office

    $229.17

    Facility

    $141.28

    $34.32 lower than Austin for the office setting.

  • New Orleans

    Louisiana · 40820

    Office

    $240.86

    Facility

    $147.82

    $22.63 lower than Austin for the office setting.

  • Rest Of Louisiana

    Louisiana · 40820

    Office

    $228.57

    Facility

    $141.08

    $34.92 lower than Austin for the office setting.

  • Metropolitan Boston

    Massachusetts · 40820

    Office

    $292.88

    Facility

    $174.83

    $29.39 higher than Austin for the office setting.

  • Rest Of Massachusetts

    Massachusetts · 40820

    Office

    $262.64

    Facility

    $158.53

    $0.85 lower than Austin for the office setting.

  • Baltimore/Surr. Cntys

    Maryland · 40820

    Office

    $268.91

    Facility

    $162.83

    $5.42 higher than Austin for the office setting.

  • Rest Of Maryland

    Maryland · 40820

    Office

    $254.64

    Facility

    $154.59

    $8.85 lower than Austin for the office setting.

  • Rest Of Maine

    Maine · 40820

    Office

    $234.01

    Facility

    $143.05

    $29.48 lower than Austin for the office setting.

  • Southern Maine

    Maine · 40820

    Office

    $248.50

    Facility

    $150.52

    $14.99 lower than Austin for the office setting.

  • Detroit

    Michigan · 40820

    Office

    $248.49

    Facility

    $153.09

    $15.00 lower than Austin for the office setting.

  • Rest Of Michigan

    Michigan · 40820

    Office

    $235.13

    Facility

    $144.86

    $28.36 lower than Austin for the office setting.

  • Minnesota

    Minnesota · 40820

    Office

    $254.55

    Facility

    $152.81

    $8.94 lower than Austin for the office setting.

  • Metropolitan Kansas City

    Missouri · 40820

    Office

    $239.65

    Facility

    $146.82

    $23.84 lower than Austin for the office setting.

  • Metropolitan St. Louis

    Missouri · 40820

    Office

    $242.42

    Facility

    $148.30

    $21.07 lower than Austin for the office setting.

  • Rest Of Missouri

    Missouri · 40820

    Office

    $223.98

    Facility

    $138.75

    $39.51 lower than Austin for the office setting.

  • Mississippi

    Mississippi · 40820

    Office

    $222.59

    Facility

    $137.47

    $40.90 lower than Austin for the office setting.

  • Montana**

    Montana · 40820

    Office

    $252.17

    Facility

    $153.30

    $11.32 lower than Austin for the office setting.

  • North Carolina

    North Carolina · 40820

    Office

    $236.74

    Facility

    $144.50

    $26.75 lower than Austin for the office setting.

  • North Dakota**

    North Dakota · 40820

    Office

    $249.20

    Facility

    $150.33

    $14.29 lower than Austin for the office setting.

  • Nebraska

    Nebraska · 40820

    Office

    $233.40

    Facility

    $142.14

    $30.09 lower than Austin for the office setting.

  • New Hampshire

    New Hampshire · 40820

    Office

    $259.89

    Facility

    $156.97

    $3.60 lower than Austin for the office setting.

  • Northern Nj

    New Jersey · 40820

    Office

    $287.82

    Facility

    $173.13

    $24.33 higher than Austin for the office setting.

  • Rest Of New Jersey

    New Jersey · 40820

    Office

    $273.13

    Facility

    $165.16

    $9.64 higher than Austin for the office setting.

  • New Mexico

    New Mexico · 40820

    Office

    $236.30

    Facility

    $145.64

    $27.19 lower than Austin for the office setting.

  • Nevada**

    Nevada · 40820

    Office

    $251.54

    Facility

    $152.58

    $11.95 lower than Austin for the office setting.

  • Nyc Suburbs/Long Island

    New York · 40820

    Office

    $297.72

    Facility

    $180.16

    $34.23 higher than Austin for the office setting.

  • Poughkpsie/N Nyc Suburbs

    New York · 40820

    Office

    $274.52

    Facility

    $166.26

    $11.03 higher than Austin for the office setting.

  • Queens

    New York · 40820

    Office

    $294.21

    Facility

    $177.35

    $30.72 higher than Austin for the office setting.

  • Rest Of New York

    New York · 40820

    Office

    $240.52

    Facility

    $146.59

    $22.97 lower than Austin for the office setting.

  • Ohio

    Ohio · 40820

    Office

    $234.52

    Facility

    $144.25

    $28.97 lower than Austin for the office setting.

  • Oklahoma

    Oklahoma · 40820

    Office

    $229.29

    Facility

    $141.01

    $34.20 lower than Austin for the office setting.

  • Portland

    Oregon · 40820

    Office

    $274.17

    Facility

    $164.33

    $10.68 higher than Austin for the office setting.

  • Rest Of Oregon

    Oregon · 40820

    Office

    $249.88

    Facility

    $151.40

    $13.61 lower than Austin for the office setting.

  • Metropolitan Philadelphia

    Pennsylvania · 40820

    Office

    $262.27

    Facility

    $159.35

    $1.22 lower than Austin for the office setting.

  • Rest Of Pennsylvania

    Pennsylvania · 40820

    Office

    $235.22

    Facility

    $144.46

    $28.27 lower than Austin for the office setting.

  • Puerto Rico

    Puerto Rico · 40820

    Office

    $254.34

    Facility

    $154.38

    $9.15 lower than Austin for the office setting.

  • Rhode Island

    Rhode Island · 40820

    Office

    $259.18

    Facility

    $157.05

    $4.31 lower than Austin for the office setting.

  • South Carolina

    South Carolina · 40820

    Office

    $235.97

    Facility

    $144.61

    $27.52 lower than Austin for the office setting.

  • South Dakota**

    South Dakota · 40820

    Office

    $248.85

    Facility

    $149.98

    $14.64 lower than Austin for the office setting.

  • Tennessee

    Tennessee · 40820

    Office

    $231.35

    Facility

    $141.48

    $32.14 lower than Austin for the office setting.

  • Utah

    Utah · 40820

    Office

    $239.46

    Facility

    $146.53

    $24.03 lower than Austin for the office setting.

  • Virginia

    Virginia · 40820

    Office

    $247.25

    Facility

    $150.06

    $16.24 lower than Austin for the office setting.

  • Virgin Islands

    United States Virgin Islands · 40820

    Office

    $254.34

    Facility

    $154.38

    $9.15 lower than Austin for the office setting.

  • Vermont

    Vermont · 40820

    Office

    $247.67

    Facility

    $149.79

    $15.82 lower than Austin for the office setting.

  • Rest Of Washington

    Washington · 40820

    Office

    $262.33

    Facility

    $158.22

    $1.16 lower than Austin for the office setting.

  • Seattle (King Cnty)

    Washington · 40820

    Office

    $299.62

    Facility

    $178.31

    $36.13 higher than Austin for the office setting.

  • Wisconsin

    Wisconsin · 40820

    Office

    $240.17

    Facility

    $145.45

    $23.32 lower than Austin for the office setting.

  • West Virginia

    West Virginia · 40820

    Office

    $227.69

    Facility

    $141.77

    $35.80 lower than Austin for the office setting.

  • Wyoming**

    Wyoming · 40820

    Office

    $250.87

    Facility

    $152.01

    $12.62 lower than Austin for the office setting.

See how rates vary across the country

40820 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.

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 all state and territory rates as a table
State / territoryRate 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

Explore 40820 on the national rate map →

Where does this rate apply?

Austin is a Medicare payment area. Our Census mapping connects it to 31 cities and communities in Texas, including the examples shown here.

Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.

Browse all communities in Texas →

Why are the office and facility amounts different?

For 40820 in Austin, the physician’s office rate is $263.49 and the facility-setting rate is $158.89: a difference of $104.60.

The calculation uses a different practice-expense RVU for each setting. Both amounts here are physician fee-schedule amounts. The facility figure does not include a hospital’s separate charges, so this comparison does not tell you the total cost of receiving care in each setting.

See the inputs behind this difference →

Use this rate

What is a percentage of Medicare worth?

Turn a percentage into dollars for 40820 in Austin. This uses the base rate on this page, so the locality and release stay consistent.

Reference amount per service

$289.84

$263.49 × 110% = $289.84

A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.

Working with a whole code list?

Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.

Compare your contract offer →

How this local rate is calculated

Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 40820 in Austin.

PPRRVU2026_Oct_nonQPP.csv

4,869

Code
40820
Physician work
1.31
Practice expense
6.09
Malpractice
0.15

GPCI2026.csv

96

Locality
Austin
Physician work
1.002
Practice expense
1.058
Malpractice
0.886
Office / nonfacility calculation for 40820 in Austin
ComponentRVULocality factorAdjusted
Physician work1.31× 1.0021.3126
Practice expense6.09× 1.0586.4432
Malpractice0.15× 0.8860.1329
Total RVUs7.8887
Conversion factor× 33.4009

Office / nonfacility rate, Austin$263.49

Open 40820 in the RVU calculator →

Explore RVUs, geographic factors and the full formula

Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work1.311.002
Practice expense6.091.058
Malpractice0.150.886

(1.31 × 1.002 + 6.09 × 1.058 + 0.15 × 0.886) × $33.4009 = $263.49

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work1.311.002
Practice expense3.131.058
Malpractice0.150.886

(1.31 × 1.002 + 3.13 × 1.058 + 0.15 × 0.886) × $33.4009 = $158.89

The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.

How this rate has changed

40820 · Office / nonfacility

$263.49

Effective 2026-10-01

The base rate is $7.97 higher than on 2025-10-01, moving from $255.52 to $263.49 (3.1%).

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

    $255.52changed to$263.49

    • 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 1.000 changed to 1.002
    • Practice expense GPCI 1.046 changed to 1.058
    • Malpractice GPCI 0.914 changed to 0.886

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    Earliest loaded release: $255.52

    Held through RVU25B, RVU25C, RVU25D.

Explore release dates and calculate this code in an earlier period →

Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.

Inspect every release and its CMS source
Effective fromOffice / nonfacilityFacilityCMS release
2026-10-01$263.49$158.89RVU26D
2026-07-01$263.49$158.89RVU26C
2026-04-01$263.49$158.89RVU26B
2026-01-01$263.49$158.89RVU26A
2025-10-01$255.52$165.52RVU25D
2025-07-01$255.52$165.52RVU25C
2025-04-01$255.52$165.52RVU25B
2025-01-01$255.52$165.52RVU25A

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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.

Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.

RVUs for 40820PPRRVU2026_Oct_nonQPP.csv, line 4,869 (RVU26D)
Geographic factors for AustinGPCI2026.csv, line 96 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet