Billing code 40812: Oral lesion excisionMedicare rate & RVUs in Florida
Reports excision of a lesion in the mouth vestibule when the resulting defect is closed with a simple repair.
Medicare pays $277.55–$304.02 for 40812 in the office in Florida, from Rest Of Florida to Miami. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 40812 covers
The clinician removes a lesion from the oral vestibule, the space between the lips or cheeks and the teeth or gums, and closes the resulting defect with a simple repair. Oral and maxillofacial surgeons, otolaryngologists, and other clinicians who perform oral surgery may provide this service in an office or facility setting. The code describes lesion removal with closure, rather than a diagnostic tissue sample alone or treatment of an abscess.
Report the code when the operative note identifies the vestibular site, excision, and simple repair. A 10-day global period includes related postoperative visits during that period. When multiple procedures are performed in the same session, Medicare pays the highest-valued procedure in full and reduces the others to 50%. Modifier 50 is inappropriate for this code’s anatomy. 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 40812 pays more and less in Florida
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$277.55 to $304.02
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale | $291.59 | $177.23 |
| Miami | $304.02 | $186.49 |
| Rest Of Florida | $277.55 | $169.63 |
How the 40812 rate is calculated
Each of 40812’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 · 40812
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 2.31Practice expense 5.82Malpractice 0.29
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 40812
40812 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 40812
Oral lesion excision
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 40812
Oral lesion excision
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.
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
40812 without 51 · national office
$281.24
Oral lesion excision
40812-51 · Second procedure: 50%
$140.62
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%).
40812 compared with similar codes
Compare codes
40812 vs 40808 vs 40810 vs 40814 vs 40816: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 40808Mouth biopsy
- 40808 is for obtaining a diagnostic biopsy specimen. Choose 40812 when the lesion is excised and the resulting defect is simply repaired.
- 40810Mouth lesion excision
- 40810 describes vestibular lesion excision without repair; 40812 includes simple repair of the defect.
- 40814Oral lesion excision
- 40814 is for excision with complex repair. 40812 applies when the repair is simple.
- 40816Mouth lesion excision
- 40816 describes radical resection of a vestibular lesion, not the excision with simple repair represented by 40812.
40812 billing questions
How does this differ from 40810?
40812 includes simple repair of the defect after lesion excision. 40810 describes excision without repair.
When is 40814 more appropriate?
Use 40814 when the excision requires complex repair. The operative note should support the repair performed, not just the lesion’s size or diagnosis.
Can 40812 be reported for a biopsy?
A diagnostic sample without definitive lesion removal points to 40808. Report 40812 when the lesion is excised and the defect receives simple repair.
Should modifier 50 be appended for lesions on both sides?
No. Modifier 50 is inappropriate for this oral-vestibule service.
How are other procedures in the same session paid?
Medicare pays the highest-valued procedure in full and reduces other procedures in the session to 50%. Related postoperative visits during the 10-day global period are included.
Does Medicare pay an assistant or co-surgeon for this service?
Medicare does not pay an assistant at surgery for this code. 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 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
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