Billing code 21040: Mandibular lesion excisionMedicare rate & RVUs in Minnesota
Reports intraoral removal of a benign lesion of the mandible when the procedure requires more than routine dental extraction or simple cyst care.
Medicare pays $474.81 for 21040 in the office in Minnesota (Minnesota). 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 21040 covers
billing code 21040 describes removal of a benign tumor or cyst from the mandible through an intraoral approach. Oral and maxillofacial surgeons and other surgeons with appropriate training may perform it in an office, ambulatory surgery center, or hospital operating room. The operative work may involve incising oral mucosa, exposing the mandibular lesion, removing it, and closing the site. The code is for a benign lesion, not a malignant jaw tumor or an exostosis.
Select the code based on the documented lesion, mandibular site, and intraoral route; distinguish it from procedures that require osteotomy, address a different jaw, or remove bone for another indication. The operative report should describe the lesion and approach, the removal performed, and any relevant pathology. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery; 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.
21040 in Minnesota
| Payment locality | Office | Facility |
|---|---|---|
| Minnesota | $474.81 | $328.39 |
How the 21040 rate is calculated
Each of 21040’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 · 21040
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 4.79Practice expense 8.99Malpractice 0.59
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 21040
21040 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21040
Mandibular lesion excision
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 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) | 0.10/0.69/0.21 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 21040
Mandibular lesion excision
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
21040 without 51 · national office
$479.97
Mandibular lesion excision
21040-51 · Second procedure: 50%
$239.99
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%).
21040 compared with similar codes
Compare codes
21040 vs 21046 vs 21047 vs 21044 vs 21030: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 21046Mandibular lesion excision
- Use 21040 for intraoral removal of a benign mandibular lesion without the osteotomy specified for 21046. The operative report should establish whether osteotomy was required.
- 21047Jaw cyst excision
- 21047 describes benign mandibular lesion removal requiring an extraoral osteotomy. 21040 describes an intraoral approach.
- 21044Jaw tumor excision
- 21040 is for a benign mandibular lesion; 21044 is used for the applicable malignant mandibular tumor procedure.
- 21030Bone lesion excision
- Both address benign jaw lesions, but 21030 is for the maxilla and 21040 is for the mandible.
21040 billing questions
How is 21040 different from 21046?
21040 is for intraoral removal of a benign mandibular lesion without the osteotomy described for 21046. Report 21046 when the documented procedure requires that intraoral osteotomy.
Can 21040 be reported for a malignant mandibular lesion?
No. This code is for a benign lesion; a malignant mandibular tumor requires the code that describes the applicable malignant-tumor procedure.
What documentation supports 21040?
Document the mandibular location, benign lesion or cyst diagnosis, intraoral approach, and the removal performed. Include pathology findings when available.
Should modifier 50 be used for lesions on both sides?
No. The CMS bilateral adjustment is not appropriate for this code, so do not report it with modifier 50.
How does the 90-day global period affect postoperative visits?
The day-before preoperative visit and related postoperative care during the 90-day period are included in the surgical global package.
Can an assistant or co-surgeon be paid for this procedure?
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 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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