$262.07
Both involve excision of a vestibular mouth lesion and repair. The repair documented for 40814 must be complex; 40812 describes simple repair.
On this page
CMS RVU26D · Effective 2026-10-01
40814 Oral lesion excision Medicare reimbursement rates in Indiana
Report this service when a lesion of the mouth vestibule is excised and the resulting site requires complex repair. Compare 40814 office and facility rates across CMS payment localities in Indiana.
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 40814 in Indiana?
Indiana 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
$356.09
1 of 1 localities have a supported rate.
Payment area: Indiana
One mapped payment locality.
Facility setting
$247.11
1 of 1 localities have a supported rate.
Payment area: Indiana
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.
Oral surgery
About 40814: Vestibular mouth lesion excision with complex repair
Report this service when a lesion of the mouth vestibule is excised and the resulting site requires complex repair.
Code 40814 describes excision of a lesion from the mucosa and submucosa of the mouth vestibule, followed by complex repair. The vestibule is the space between the lips or cheeks and the teeth or gums; examples include the inner lip or cheek lining. Oral and maxillofacial surgeons, otolaryngologists, and other surgeons may perform the procedure in an office, ambulatory surgery center, or hospital. A specimen may be sent for pathologic examination, but the operative service is selected by the excision and repair performed, not by the final diagnosis.
Choose this code when the operative report supports a complex repair, rather than no repair or simple repair. Document the lesion’s site, the excision performed, and the repair technique and complexity. Medicare assigns a 90-day global period, which includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in one session, the highest-valued procedure is paid in full and the others at 50%. Modifier 50 is inappropriate. Assistant-at-surgery payment is restricted; co-surgeons and team surgery are not permitted.
CMS billing rules for 40814
- 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 RVU3.43 · 30%
- Practice expense (office) RVU7.57 · 66%
- Malpractice RVU0.44 · 4%
587
Medicare services in 2024 · #3411 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.
40814 compared with similar codes
Office rates for Indiana, from the same CMS release.
$200.92
40810 is for excision without repair. Choose 40814 when the site is closed with a complex repair.
$380.43
40816 describes full-thickness excision and closure. 40814 applies to mucosa and submucosa excision with complex repair.
$156.17
40808 is for biopsy of a mouth lesion. 40814 is for lesion excision with complex repair, rather than sampling alone.
Compare 40814 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
Indiana →
Office / nonfacility
$356.09
Facility
$247.11
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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 40814 in Indiana.
PPRRVU2026_Oct_nonQPP.csv
4,865
- Code
- 40814
- Physician work
- 3.43
- Practice expense
- 7.57
- Malpractice
- 0.44
GPCI2026.csv
52
- Locality
- Indiana
- Physician work
- 1.000
- Practice expense
- 0.927
- Malpractice
- 0.486
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.43 | × 1.000 | 3.4300 |
| Practice expense | 7.57 | × 0.927 | 7.0174 |
| Malpractice | 0.44 | × 0.486 | 0.2138 |
| Total RVUs | 10.6612 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Indiana$356.09
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.43 | 1 |
| Practice expense | 7.57 | 0.927 |
| Malpractice | 0.44 | 0.486 |
(3.43 × 1 + 7.57 × 0.927 + 0.44 × 0.486) × $33.4009 = $356.09
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.43 | 1 |
| Practice expense | 4.05 | 0.927 |
| Malpractice | 0.44 | 0.486 |
(3.43 × 1 + 4.05 × 0.927 + 0.44 × 0.486) × $33.4009 = $247.11
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.
40814 billing questions
How does 40814 differ from 40812?
Both describe vestibular lesion excision with repair. Use 40814 when the documentation supports complex repair; 40812 is for simple repair.
When is 40810 a better choice?
40810 describes excision without repair. Use 40814 when the excision site receives a complex repair.
Should 40814 be reported for a biopsy?
Use 40814 for excision with complex repair, not for a diagnostic sample alone. Code 40808 describes biopsy of a mouth lesion.
Can modifier 50 be appended for lesions on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be paid?
Assistant-at-surgery payment is restricted 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 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.
4,86240808,,Biopsy of mouth lesion,A,,1.02,3.87,,1.31,,0.14,5.03,2.47,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,86340810,,Excision of mouth lesion,A,,1.33,4.96,,1.93,,0.18,6.47,3.44,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,86440812,,Excise/repair mouth lesion,A,,2.31,5.82,,2.44,,0.29,8.42,5.04,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,86540814,,Excise/repair mouth lesion,A,,3.43,7.57,,4.05,,0.44,11.44,7.92,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,86640816,,Excision of mouth lesion,A,,3.68,8.06,,4.21,,0.49,12.23,8.38,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,86740818,,Excise oral mucosa for graft,A,,2.76,7.80,,4.27,,0.35,10.91,7.38,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,86840819,,Excise lip or cheek fold,A,,2.45,5.57,,2.93,,0.27,8.29,5.65,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915