$174.45–$193.97
40808 is for obtaining tissue to establish a diagnosis. Choose 40820 when the clinician treats the lesion rather than taking a diagnostic sample.
On this page
CMS RVU26D · Effective 2026-10-01
40820 Oral lesion treatment Medicare reimbursement rates in Massachusetts
Report this service when a clinician treats a mucosal lesion in the vestibule of the mouth without repairing the treated area. Compare 40820 office and facility rates across CMS payment localities in Massachusetts.
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 40820 in Massachusetts?
Massachusetts has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$262.64–$292.88
2 of 2 localities have a supported rate.
Facility setting
$158.53–$174.83
2 of 2 localities have a supported rate.
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 40820: Vestibular oral mucosal lesion treatment
Report this service when a clinician treats a mucosal lesion in the vestibule of the mouth without repairing the treated area.
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.
CMS billing rules for 40820
- Global period
- Minor procedure with a 10-day global period: related postoperative visits for 10 days 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 RVU1.31 · 17%
- Practice expense (office) RVU6.09 · 81%
- Malpractice RVU0.15 · 2%
1.8K
Medicare services in 2024 · #2565 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.
40820 compared with similar codes
Office rates for Massachusetts, from the same CMS release.
$224.37–$249.40
40810 describes excision of a vestibular lesion. Use 40820 when the lesion is treated without being excised.
$218.02–$242.69
40800 is for draining a mouth lesion, such as a fluid collection. 40820 is for treatment of a mucosal lesion, not drainage.
Compare 40820 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.
2 of 2 payment localities
Metropolitan Boston →
Office / nonfacility
$292.88
Facility
$174.83
Rest Of Massachusetts →
Office / nonfacility
$262.64
Facility
$158.53
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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 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.
4,86640816,,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
4,86940820,,Treatment of mouth lesion,A,,1.31,6.09,,3.13,,0.15,7.55,4.59,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,87040830,,Repair mouth laceration,A,,1.77,4.94,,2.15,,0.23,6.94,4.15,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,87140831,,Repair mouth laceration,A,,2.51,6.51,,2.94,,0.34,9.36,5.79,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,87240840,,Reconstruction of mouth,R,,8.92,16.17,,6.58,,1.36,26.45,16.86,0,090,0.09,0.81,0.10,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00