$157.36–$166.69
40808 is for obtaining a diagnostic biopsy specimen. Choose 40812 when the lesion is excised and the resulting defect is simply repaired.
On this page
CMS RVU26D · Effective 2026-10-01
40812 Oral lesion excision Medicare reimbursement rates in Michigan
Reports excision of a lesion in the mouth vestibule when the resulting defect is closed with a simple repair. Compare 40812 office and facility rates across CMS payment localities in Michigan.
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 40812 in Michigan?
Michigan 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
$265.57–$281.08
2 of 2 localities have a supported rate.
Facility setting
$162.50–$172.13
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 40812: Vestibular mouth lesion excision with simple repair
Reports excision of a lesion in the mouth vestibule when the resulting defect is closed with a simple repair.
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.
CMS billing rules for 40812
- 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 RVU2.31 · 27%
- Practice expense (office) RVU5.82 · 69%
- Malpractice RVU0.29 · 3%
5.2K
Medicare services in 2024 · #1850 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.
40812 compared with similar codes
Office rates for Michigan, from the same CMS release.
$202.47–$214.43
40810 describes vestibular lesion excision without repair; 40812 includes simple repair of the defect.
$362.00–$383.34
40814 is for excision with complex repair. 40812 applies when the repair is simple.
$387.18–$410.30
40816 describes radical resection of a vestibular lesion, not the excision with simple repair represented by 40812.
Compare 40812 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
Detroit →
Office / nonfacility
$281.08
Facility
$172.13
Rest Of Michigan →
Office / nonfacility
$265.57
Facility
$162.50
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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 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.
4,86140806,,Incision of lip fold,A,,0.30,2.67,,0.50,,0.06,3.03,0.86,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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