Billing code 41825: Gum lesion excisionMedicare rate & RVUs in Illinois
Surgical removal of a localized gum lesion, reported when the provider excises abnormal gingival tissue rather than draining a collection or removing a foreign body.
Medicare pays $204.58–$224.82 for 41825 in the office in Illinois, from Rest Of Illinois to Suburban Chicago. 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 41825 covers
An oral surgeon or other qualified dental or medical provider uses this service to surgically remove a localized lesion arising in the gum tissue. A typical clinical situation is removal of a discrete gingival growth, such as a fibrous or irritation-related lesion, in an office or surgical setting. The code concerns excision; drainage of a fluid collection and removal of a foreign body are different services.
Choose this code when the operative documentation identifies the gingival lesion and describes its excision. Record the site, the tissue removed, and the procedure performed so the service can be distinguished from quadrant-based gum removal or excision of a gingival flap. CMS assigns a 10-day global period, including related postoperative visits during that period. 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 multiple-procedure reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment is statutorily restricted, and 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 41825 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
4 payment localities
$204.58 to $224.82
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | $224.36 | $119.29 |
| East St. Louis | $208.44 | $112.26 |
| Rest Of Illinois | $204.58 | $109.13 |
| Suburban Chicago | $224.82 | $117.45 |
How the 41825 rate is calculated
Each of 41825’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 · 41825
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.37Practice expense 4.90Malpractice 0.18
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 41825
41825 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 41825
Gum 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 · 41825
Gum 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
41825 without 51 · national office
$215.44
Gum lesion excision
41825-51 · Second procedure: 50%
$107.72
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%).
41825 compared with similar codes
Compare codes
41825 vs 41800 vs 41820 vs 41821: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 41800Gum drainage
- 41800 represents drainage of a gum lesion. Use 41825 when the documented procedure excises the lesion rather than opening it to drain.
- 41820Excision gum each quadrant
- 41820 describes gum-tissue excision by quadrant. Use 41825 for excision of a localized gum lesion, not a quadrant-based removal.
- 41821Excision of gum flap
- 41821 is for excision of a gingival flap. Use 41825 when the operative report describes removal of a gum lesion instead of a flap.
41825 billing questions
How is this different from drainage of a gum lesion?
Report 41825 for excision of gingival tissue. Code 41800 describes drainage, such as opening a collection to release its contents.
Is this the same as quadrant-based gum excision?
No. Code 41820 is defined by excision of gum tissue by quadrant; 41825 concerns excision of a gum lesion. The operative note should support the service actually performed.
Can modifier 50 be used for lesions on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code; do not report modifier 50.
Are related postoperative visits included?
Yes. The code has a 10-day global period, so related postoperative visits during those 10 days are included.
How are other procedures in the same session paid?
Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and the other procedures are reduced to 50% when performed in the same session.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment is statutorily restricted. Co-surgeons and team surgery are not permitted for this code.
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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