$147.51
40490 is for lip tissue; 40808 is for a lesion in the vestibule of the mouth. Base selection on the documented biopsy site.
On this page
CMS RVU26D · Effective 2026-10-01
40490 Lip biopsy Medicare reimbursement rates in Arkansas
Reports a biopsy of lip tissue to obtain a specimen from a suspicious lip lesion for diagnostic examination. Compare 40490 office and facility rates across CMS payment localities in Arkansas.
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.
What does Medicare pay for 40490 in Arkansas?
Arkansas has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$107.51
1 of 1 localities have a supported rate.
Payment area: Arkansas
One mapped payment locality.
Facility setting
$52.43
1 of 1 localities have a supported rate.
Payment area: Arkansas
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Surgical procedure
About 40490: Lip lesion biopsy
Reports a biopsy of lip tissue to obtain a specimen from a suspicious lip lesion for diagnostic examination.
A clinician removes a tissue sample from a lip lesion for diagnostic evaluation. This service is commonly performed by dermatologists, otolaryngologists, oral surgeons, and other clinicians who evaluate lip abnormalities in an office or facility setting. The target must be on the lip; a lesion elsewhere in the mouth has a site-specific biopsy code. A biopsy obtains a diagnostic sample rather than removing a lesion as definitive treatment.
Select the code from the documented biopsy site and procedure, and retain the operative note describing the lip location, lesion, and tissue sampled. The specimen may be sent for separate pathology evaluation. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is 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 code. CMS does not pay for an assistant at surgery, co-surgeons, or team surgery for this service.
CMS billing rules for 40490
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is 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 RVU1.19 · 33%
- Practice expense (office) RVU2.29 · 64%
- Malpractice RVU0.12 · 3%
26.4K
Medicare services in 2024 · #1026 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.
40490 compared with similar codes
Office rates for Arkansas, from the same CMS release.
$165.85
Use 41100 when the sampled lesion is on the tongue. A lip lesion is reported with 40490.
$106.93
11104 describes a punch biopsy of a skin lesion. Consider it for a skin target outside the lip, rather than a biopsy of lip tissue.
Compare 40490 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Arkansas →
Office / nonfacility
$107.51
Facility
$52.43
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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 40490 in Arkansas.
PPRRVU2026_Oct_nonQPP.csv
4,819
- Code
- 40490
- Physician work
- 1.19
- Practice expense
- 2.29
- Malpractice
- 0.12
GPCI2026.csv
7
- Locality
- Arkansas
- Physician work
- 1.000
- Practice expense
- 0.859
- Malpractice
- 0.515
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.19 | × 1.000 | 1.1900 |
| Practice expense | 2.29 | × 0.859 | 1.9671 |
| Malpractice | 0.12 | × 0.515 | 0.0618 |
| Total RVUs | 3.2189 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Arkansas$107.51
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.19 | 1 |
| Practice expense | 2.29 | 0.859 |
| Malpractice | 0.12 | 0.515 |
(1.19 × 1 + 2.29 × 0.859 + 0.12 × 0.515) × $33.4009 = $107.51
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.19 | 1 |
| Practice expense | 0.37 | 0.859 |
| Malpractice | 0.12 | 0.515 |
(1.19 × 1 + 0.37 × 0.859 + 0.12 × 0.515) × $33.4009 = $52.43
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.
40490 billing questions
How is 40490 distinguished from a biopsy elsewhere in the mouth?
Use 40490 when the sampled tissue is on the lip. Biopsies of the tongue, floor of mouth, palate, or oral vestibule have site-specific codes.
Is 40490 a biopsy or an excision?
It reports obtaining a diagnostic tissue sample from the lip. If the procedure removes a lesion rather than sampling it for diagnosis, evaluate the applicable excision code instead.
Can modifier 50 be used when both lips are sampled?
No. CMS bilateral adjustment does not apply to 40490, and modifier 50 is inappropriate for this descriptor and anatomy.
What same-day care is included?
The 0-day global period includes the related preoperative and postoperative care furnished on the procedure date.
How does CMS handle 40490 with another procedure in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction, with payment at 50%.
What documentation supports reporting 40490?
Document that the sampled lesion is on the lip, its location and clinical description, and the tissue obtained. Include the procedure details and specimen disposition.
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.
4,8164046F,,Doc antibio given b/4 surg,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
4,8174047F,,Doc antibio given b/4 surg,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
4,8184048F,,Doc antibio given b/4 surg,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
4,81940490,,Biopsy of lip,A,,1.19,2.29,,0.37,,0.12,3.60,1.68,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,8204049F,,Doc order given stop antibio,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
4,82140500,,Partial excision of lip,A,,4.36,10.87,,5.04,,0.57,15.80,9.97,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,8224050F,,Ht care plan doc,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
410112,AL,00,ALABAMA,1.000,0.875,0.566
502102,AK,01,ALASKA*,1.500,1.065,0.551
603102,AZ,00,ARIZONA,1.000,0.969,0.856
707102,AR,13,ARKANSAS,1.000,0.859,0.515
801112,CA,54,BAKERSFIELD,1.019,1.096,0.609
901112,CA,55,CHICO,1.017,1.096,0.536
1001182,CA,71,EL CENTRO,1.017,1.096,0.541