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CMS RVU26D · Effective 2026-10-01

40816 in El Centro

Office / nonfacility

$428.91

Base rate per service

Facility setting

$287.98

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 40816: Vestibular mouth lesion excision with graft

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

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.

CMS billing rules for 40816

Global period
Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care 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 RVU3.68 · 30%
  • Practice expense (office) RVU8.06 · 66%
  • Malpractice RVU0.49 · 4%

522

Medicare services in 2024 · #3523 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.

40816 compared with similar codes

Office rates for El Centro, from the same CMS release.

40810

Mouth lesion excision

Without repair

$230.00

Use 40810 for vestibular lesion excision without repair. 40816 describes excision followed by full-thickness skin graft closure.

40812

Oral lesion excision

Simple repair

$296.76

40812 describes lesion excision with simple repair; 40816 is distinguished by full-thickness skin graft closure.

40814

Oral lesion excision

Complex repair

$401.58

40814 describes complex repair after lesion excision. Use 40816 when the documented closure uses a full-thickness skin graft.

40818

Oral graft harvest

Vestibular mucosa

$385.62

40818 describes taking vestibular mucosa as a donor graft. 40816 describes excising a lesion and closing its defect with a full-thickness skin graft.

The same code, a different location

How does El Centro compare?

In Bakersfield, the office rate for 40816 is $430.27—$1.36 higher than the $428.91 rate in El Centro. Both use the same code, release and participation basis.

40816 across payment areas

Same release and payment basis · bars start at $0

  1. El Centro · This locality

    $428.91

  2. Bakersfield

    $430.27

    $1.36 higher than El Centro

  3. Chico

    $428.83

    $0.08 lower than El Centro

  4. Fresno

    $428.83

    $0.08 lower than El Centro

  5. Hanford-Corcoran

    $428.83

    $0.08 lower than El Centro

  6. Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty)

    $457.30

    $28.39 higher than El Centro

  7. Madera

    $428.83

    $0.08 lower than El Centro

Other payment areas listed in California 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, 40816 ranges from $362.60 in Arkansas to $533.41 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

  • Merced

    California · 40816

    Office

    $428.83

    Facility

    $287.89

    $0.08 lower than El Centro for the office setting.

  • Modesto

    California · 40816

    Office

    $428.83

    Facility

    $287.89

    $0.08 lower than El Centro for the office setting.

  • Napa

    California · 40816

    Office

    $493.79

    Facility

    $324.31

    $64.88 higher than El Centro for the office setting.

  • Oxnard-Thousand Oaks-Ventura

    California · 40816

    Office

    $454.76

    Facility

    $302.76

    $25.85 higher than El Centro for the office setting.

  • Redding

    California · 40816

    Office

    $428.83

    Facility

    $287.89

    $0.08 lower than El Centro for the office setting.

  • Rest Of California

    California · 40816

    Office

    $428.83

    Facility

    $287.89

    $0.08 lower than El Centro for the office setting.

  • Riverside-San Bernardino-Ontario

    California · 40816

    Office

    $434.14

    Facility

    $293.21

    $5.23 higher than El Centro for the office setting.

  • Sacramento-Roseville-Folsom

    California · 40816

    Office

    $449.21

    Facility

    $299.65

    $20.30 higher than El Centro for the office setting.

  • Salinas

    California · 40816

    Office

    $447.51

    Facility

    $298.47

    $18.60 higher than El Centro for the office setting.

  • San Diego-Chula Vista-Carlsbad

    California · 40816

    Office

    $457.45

    Facility

    $303.65

    $28.54 higher than El Centro for the office setting.

  • San Francisco-Oakland-Berkeley (Marin Cnty)

    California · 40816

    Office

    $521.69

    Facility

    $340.38

    $92.78 higher than El Centro for the office setting.

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

    California · 40816

    Office

    $521.14

    Facility

    $339.82

    $92.23 higher than El Centro for the office setting.

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

    California · 40816

    Office

    $533.41

    Facility

    $347.98

    $104.50 higher than El Centro for the office setting.

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

    California · 40816

    Office

    $531.14

    Facility

    $345.70

    $102.23 higher than El Centro for the office setting.

  • San Luis Obispo-Paso Robles

    California · 40816

    Office

    $440.41

    Facility

    $293.94

    $11.50 higher than El Centro for the office setting.

  • Santa Cruz-Watsonville

    California · 40816

    Office

    $461.36

    Facility

    $305.12

    $32.45 higher than El Centro for the office setting.

  • Santa Maria-Santa Barbara

    California · 40816

    Office

    $449.03

    Facility

    $299.09

    $20.12 higher than El Centro for the office setting.

  • Santa Rosa-Petaluma

    California · 40816

    Office

    $465.97

    Facility

    $308.05

    $37.06 higher than El Centro for the office setting.

  • Stockton

    California · 40816

    Office

    $428.83

    Facility

    $287.89

    $0.08 lower than El Centro for the office setting.

  • Vallejo

    California · 40816

    Office

    $492.99

    Facility

    $323.51

    $64.08 higher than El Centro for the office setting.

  • Visalia

    California · 40816

    Office

    $428.83

    Facility

    $287.89

    $0.08 lower than El Centro for the office setting.

  • Yuba City

    California · 40816

    Office

    $428.83

    Facility

    $287.89

    $0.08 lower than El Centro for the office setting.

  • Dc + Md/Va Suburbs

    District of Columbia · 40816

    Office

    $464.90

    Facility

    $313.42

    $35.99 higher than El Centro for the office setting.

  • Miami

    Florida · 40816

    Office

    $444.55

    Facility

    $310.69

    $15.64 higher than El Centro for the office setting.

  • Chicago

    Illinois · 40816

    Office

    $431.89

    Facility

    $302.66

    $2.98 higher than El Centro for the office setting.

  • Manhattan

    New York · 40816

    Office

    $469.56

    Facility

    $320.14

    $40.65 higher than El Centro for the office setting.

  • Alaska*

    Alaska · 40816

    Office

    $480.10

    Facility

    $343.15

    $51.19 higher than El Centro for the office setting.

  • Alabama

    Alabama · 40816

    Office

    $367.74

    Facility

    $255.22

    $61.17 lower than El Centro for the office setting.

  • Arkansas

    Arkansas · 40816

    Office

    $362.60

    Facility

    $252.13

    $66.31 lower than El Centro for the office setting.

  • Arizona

    Arizona · 40816

    Office

    $397.79

    Facility

    $273.18

    $31.12 lower than El Centro for the office setting.

  • Colorado

    Colorado · 40816

    Office

    $423.61

    Facility

    $286.79

    $5.30 lower than El Centro for the office setting.

  • Connecticut

    Connecticut · 40816

    Office

    $435.12

    Facility

    $296.62

    $6.21 higher than El Centro for the office setting.

  • Delaware

    Delaware · 40816

    Office

    $404.22

    Facility

    $277.17

    $24.69 lower than El Centro for the office setting.

  • Fort Lauderdale

    Florida · 40816

    Office

    $425.22

    Facility

    $294.95

    $3.69 lower than El Centro for the office setting.

  • Rest Of Florida

    Florida · 40816

    Office

    $404.88

    Facility

    $281.94

    $24.03 lower than El Centro for the office setting.

  • Atlanta

    Georgia · 40816

    Office

    $416.46

    Facility

    $285.81

    $12.45 lower than El Centro for the office setting.

  • Rest Of Georgia

    Georgia · 40816

    Office

    $382.56

    Facility

    $267.86

    $46.35 lower than El Centro for the office setting.

  • Hawaii, Guam

    Hawaii · 40816

    Office

    $438.48

    Facility

    $292.27

    $9.57 higher than El Centro for the office setting.

  • Iowa

    Iowa · 40816

    Office

    $375.74

    Facility

    $258.08

    $53.17 lower than El Centro for the office setting.

  • Idaho

    Idaho · 40816

    Office

    $378.33

    Facility

    $260.03

    $50.58 lower than El Centro for the office setting.

  • East St. Louis

    Illinois · 40816

    Office

    $403.55

    Facility

    $285.25

    $25.36 lower than El Centro for the office setting.

  • Rest Of Illinois

    Illinois · 40816

    Office

    $394.29

    Facility

    $276.88

    $34.62 lower than El Centro for the office setting.

  • Suburban Chicago

    Illinois · 40816

    Office

    $429.26

    Facility

    $297.19

    $0.35 higher than El Centro for the office setting.

  • Indiana

    Indiana · 40816

    Office

    $380.43

    Facility

    $261.22

    $48.48 lower than El Centro for the office setting.

  • Kansas

    Kansas · 40816

    Office

    $374.53

    Facility

    $258.28

    $54.38 lower than El Centro for the office setting.

  • Kentucky

    Kentucky · 40816

    Office

    $377.22

    Facility

    $262.90

    $51.69 lower than El Centro for the office setting.

  • New Orleans

    Louisiana · 40816

    Office

    $394.84

    Facility

    $273.83

    $34.07 lower than El Centro for the office setting.

  • Rest Of Louisiana

    Louisiana · 40816

    Office

    $376.85

    Facility

    $263.04

    $52.06 lower than El Centro for the office setting.

  • Metropolitan Boston

    Massachusetts · 40816

    Office

    $463.96

    Facility

    $310.42

    $35.05 higher than El Centro for the office setting.

  • Rest Of Massachusetts

    Massachusetts · 40816

    Office

    $421.41

    Facility

    $286.00

    $7.50 lower than El Centro for the office setting.

  • Baltimore/Surr. Cntys

    Maryland · 40816

    Office

    $433.99

    Facility

    $296.01

    $5.08 higher than El Centro for the office setting.

  • Rest Of Maryland

    Maryland · 40816

    Office

    $411.61

    Facility

    $281.47

    $17.30 lower than El Centro for the office setting.

  • Rest Of Maine

    Maine · 40816

    Office

    $380.77

    Facility

    $262.46

    $48.14 lower than El Centro for the office setting.

  • Southern Maine

    Maine · 40816

    Office

    $400.03

    Facility

    $272.59

    $28.88 lower than El Centro for the office setting.

  • Detroit

    Michigan · 40816

    Office

    $410.30

    Facility

    $286.21

    $18.61 lower than El Centro for the office setting.

  • Rest Of Michigan

    Michigan · 40816

    Office

    $387.18

    Facility

    $269.78

    $41.73 lower than El Centro for the office setting.

  • Minnesota

    Minnesota · 40816

    Office

    $404.78

    Facility

    $272.46

    $24.13 lower than El Centro for the office setting.

  • Metropolitan Kansas City

    Missouri · 40816

    Office

    $391.69

    Facility

    $270.95

    $37.22 lower than El Centro for the office setting.

  • Metropolitan St. Louis

    Missouri · 40816

    Office

    $395.60

    Facility

    $273.18

    $33.31 lower than El Centro for the office setting.

  • Rest Of Missouri

    Missouri · 40816

    Office

    $370.92

    Facility

    $260.07

    $57.99 lower than El Centro for the office setting.

  • Mississippi

    Mississippi · 40816

    Office

    $366.80

    Facility

    $256.08

    $62.11 lower than El Centro for the office setting.

  • Montana**

    Montana · 40816

    Office

    $408.46

    Facility

    $279.87

    $20.45 lower than El Centro for the office setting.

  • North Carolina

    North Carolina · 40816

    Office

    $384.55

    Facility

    $264.57

    $44.36 lower than El Centro for the office setting.

  • North Dakota**

    North Dakota · 40816

    Office

    $398.77

    Facility

    $270.18

    $30.14 lower than El Centro for the office setting.

  • Nebraska

    Nebraska · 40816

    Office

    $377.58

    Facility

    $258.89

    $51.33 lower than El Centro for the office setting.

  • New Hampshire

    New Hampshire · 40816

    Office

    $417.48

    Facility

    $283.62

    $11.43 lower than El Centro for the office setting.

  • Northern Nj

    New Jersey · 40816

    Office

    $460.42

    Facility

    $311.25

    $31.51 higher than El Centro for the office setting.

  • Rest Of New Jersey

    New Jersey · 40816

    Office

    $439.76

    Facility

    $299.34

    $10.85 higher than El Centro for the office setting.

  • New Mexico

    New Mexico · 40816

    Office

    $389.44

    Facility

    $271.52

    $39.47 lower than El Centro for the office setting.

  • Nevada**

    Nevada · 40816

    Office

    $406.03

    Facility

    $277.31

    $22.88 lower than El Centro for the office setting.

  • Nyc Suburbs/Long Island

    New York · 40816

    Office

    $481.27

    Facility

    $328.37

    $52.36 higher than El Centro for the office setting.

  • Poughkpsie/N Nyc Suburbs

    New York · 40816

    Office

    $443.04

    Facility

    $302.23

    $14.13 higher than El Centro for the office setting.

  • Queens

    New York · 40816

    Office

    $472.59

    Facility

    $320.59

    $43.68 higher than El Centro for the office setting.

  • Rest Of New York

    New York · 40816

    Office

    $390.17

    Facility

    $268.01

    $38.74 lower than El Centro for the office setting.

  • Ohio

    Ohio · 40816

    Office

    $385.20

    Facility

    $267.80

    $43.71 lower than El Centro for the office setting.

  • Oklahoma

    Oklahoma · 40816

    Office

    $376.04

    Facility

    $261.20

    $52.87 lower than El Centro for the office setting.

  • Portland

    Oregon · 40816

    Office

    $436.15

    Facility

    $293.28

    $7.24 higher than El Centro for the office setting.

  • Rest Of Oregon

    Oregon · 40816

    Office

    $402.56

    Facility

    $274.48

    $26.35 lower than El Centro for the office setting.

  • Metropolitan Philadelphia

    Pennsylvania · 40816

    Office

    $424.90

    Facility

    $291.04

    $4.01 lower than El Centro for the office setting.

  • Rest Of Pennsylvania

    Pennsylvania · 40816

    Office

    $385.52

    Facility

    $267.47

    $43.39 lower than El Centro for the office setting.

  • Puerto Rico

    Puerto Rico · 40816

    Office

    $411.21

    Facility

    $281.20

    $17.70 lower than El Centro for the office setting.

  • Rhode Island

    Rhode Island · 40816

    Office

    $417.94

    Facility

    $285.11

    $10.97 lower than El Centro for the office setting.

  • South Carolina

    South Carolina · 40816

    Office

    $385.58

    Facility

    $266.76

    $43.33 lower than El Centro for the office setting.

  • South Dakota**

    South Dakota · 40816

    Office

    $397.63

    Facility

    $269.03

    $31.28 lower than El Centro for the office setting.

  • Tennessee

    Tennessee · 40816

    Office

    $376.42

    Facility

    $259.53

    $52.49 lower than El Centro for the office setting.

  • Austin

    Texas · 40816

    Office

    $422.49

    Facility

    $286.44

    $6.42 lower than El Centro for the office setting.

  • Beaumont

    Texas · 40816

    Office

    $383.10

    Facility

    $266.08

    $45.81 lower than El Centro for the office setting.

  • Brazoria

    Texas · 40816

    Office

    $403.45

    Facility

    $276.02

    $25.46 lower than El Centro for the office setting.

  • Dallas

    Texas · 40816

    Office

    $406.20

    Facility

    $278.12

    $22.71 lower than El Centro for the office setting.

  • Fort Worth

    Texas · 40816

    Office

    $403.72

    Facility

    $276.93

    $25.19 lower than El Centro for the office setting.

  • Galveston

    Texas · 40816

    Office

    $404.78

    Facility

    $277.08

    $24.13 lower than El Centro for the office setting.

  • Houston

    Texas · 40816

    Office

    $413.75

    Facility

    $286.05

    $15.16 lower than El Centro for the office setting.

  • Rest Of Texas

    Texas · 40816

    Office

    $393.18

    Facility

    $271.14

    $35.73 lower than El Centro for the office setting.

  • Utah

    Utah · 40816

    Office

    $390.67

    Facility

    $269.79

    $38.24 lower than El Centro for the office setting.

  • Virginia

    Virginia · 40816

    Office

    $399.10

    Facility

    $272.70

    $29.81 lower than El Centro for the office setting.

  • Virgin Islands

    United States Virgin Islands · 40816

    Office

    $411.21

    Facility

    $281.20

    $17.70 lower than El Centro for the office setting.

  • Vermont

    Vermont · 40816

    Office

    $397.72

    Facility

    $270.41

    $31.19 lower than El Centro for the office setting.

  • Rest Of Washington

    Washington · 40816

    Office

    $420.45

    Facility

    $285.04

    $8.46 lower than El Centro for the office setting.

  • Seattle (King Cnty)

    Washington · 40816

    Office

    $472.75

    Facility

    $314.97

    $43.84 higher than El Centro for the office setting.

  • Wisconsin

    Wisconsin · 40816

    Office

    $385.86

    Facility

    $262.67

    $43.05 lower than El Centro for the office setting.

  • West Virginia

    West Virginia · 40816

    Office

    $380.28

    Facility

    $268.53

    $48.63 lower than El Centro for the office setting.

  • Wyoming**

    Wyoming · 40816

    Office

    $404.24

    Facility

    $275.64

    $24.67 lower than El Centro for the office setting.

See how rates vary across the country

40816 · 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.

$362.60

$481.12

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

View all state and territory rates as a table
State / territoryRate 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

Explore 40816 on the national rate map →

Where does this rate apply?

El Centro is a Medicare payment area. Our Census mapping connects it to 18 cities and communities in California, 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 California →

Why are the office and facility amounts different?

For 40816 in El Centro, the physician’s office rate is $428.91 and the facility-setting rate is $287.98: a difference of $140.93.

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 40816 in El Centro. This uses the base rate on this page, so the locality and release stay consistent.

Reference amount per service

$471.80

$428.91 × 110% = $471.80

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 40816 in El Centro.

PPRRVU2026_Oct_nonQPP.csv

4,866

Code
40816
Physician work
3.68
Practice expense
8.06
Malpractice
0.49

GPCI2026.csv

10

Locality
El Centro
Physician work
1.017
Practice expense
1.096
Malpractice
0.541
Office / nonfacility calculation for 40816 in El Centro
ComponentRVULocality factorAdjusted
Physician work3.68× 1.0173.7426
Practice expense8.06× 1.0968.8338
Malpractice0.49× 0.5410.2651
Total RVUs12.8414
Conversion factor× 33.4009

Office / nonfacility rate, El Centro$428.91

Open 40816 in the RVU calculator →

Explore RVUs, geographic factors and the full formula

Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work3.681.017
Practice expense8.061.096
Malpractice0.490.541

(3.68 × 1.017 + 8.06 × 1.096 + 0.49 × 0.541) × $33.4009 = $428.91

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work3.681.017
Practice expense4.211.096
Malpractice0.490.541

(3.68 × 1.017 + 4.21 × 1.096 + 0.49 × 0.541) × $33.4009 = $287.98

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

40816 · Office / nonfacility

$428.91

Effective 2026-10-01

The base rate is $17.98 higher than on 2025-10-01, moving from $410.93 to $428.91 (4.4%).

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

    $410.93changed to$428.91

    • 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 1.014 changed to 1.017
    • Practice expense GPCI 1.093 changed to 1.096
    • Malpractice GPCI 0.570 changed to 0.541

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    Earliest loaded release: $410.93

    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$428.91$287.98RVU26D
2026-07-01$428.91$287.98RVU26C
2026-04-01$428.91$287.98RVU26B
2026-01-01$428.91$287.98RVU26A
2025-10-01$410.93$308.40RVU25D
2025-07-01$410.93$308.40RVU25C
2025-04-01$410.93$308.40RVU25B
2025-01-01$410.93$308.40RVU25A

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 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 40816PPRRVU2026_Oct_nonQPP.csv, line 4,866 (RVU26D)
Geographic factors for El CentroGPCI2026.csv, line 10 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet