Billing code 40820: Oral lesion treatmentMedicare rate & RVUs in Guam
Report this service when a clinician treats a mucosal lesion in the vestibule of the mouth without repairing the treated area.
Medicare pays $277.93 for 40820 in the office in Guam (Hawaii, Guam). 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 40820 covers
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.
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 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | $277.93 | $165.52 |
How the 40820 rate is calculated
Each of 40820’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 · 40820
RVUs × geographic indexes × conversion factor
Work1.31
1.31 RVUs× 1.000 GPCI
Practice expense6.09
6.09 RVUs× 1.000 GPCI
Malpractice0.15
0.15 RVUs× 1.000 GPCI
Adjusted RVUs
7.5500
Conversion factor
$33.4009
Medicare rate
$252.18
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 40820
40820 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 40820
Oral lesion treatment
| 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 · 40820
Oral lesion treatment
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
40820 without 51 · national office
$252.18
Oral lesion treatment
40820-51 · Second procedure: 50%
$126.09
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%).
40820 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 40808Mouth biopsy
- 40808 is for obtaining tissue to establish a diagnosis. Choose 40820 when the clinician treats the lesion rather than taking a diagnostic sample.
- 40810Mouth lesion excision
- 40810 describes excision of a vestibular lesion. Use 40820 when the lesion is treated without being excised.
- 40800Oral drainage
- 40800 is for draining a mouth lesion, such as a fluid collection. 40820 is for treatment of a mucosal lesion, not drainage.
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 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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