Billing code 40808: Mouth biopsyMedicare rate & RVUs in Minnesota
Reports tissue sampling of a lesion in the oral vestibule, the space between the lips or cheeks and the teeth and gums, for diagnosis.
Medicare pays $168.46 for 40808 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 40808 covers
This service samples a lesion in the oral vestibule—the lining inside the lips or cheeks, between them and the teeth and gums. A dentist, oral surgeon, or otolaryngologist may perform it in an office or outpatient setting when a persistent ulcer, abnormal patch, or other lesion needs tissue diagnosis. The specimen is sent for pathologic examination; the code represents the biopsy procedure, not the laboratory’s tissue analysis.
Report 40808 when tissue is sampled from the vestibule rather than when the lesion is removed by excision or lies at a different oral site. Document the lesion’s location and appearance, the tissue obtained, and the procedure performed. CMS assigns 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 the others are subject to the standard 50% reduction. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery for it, 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.
40808 in Minnesota
| Payment locality | Office | Facility |
|---|---|---|
| Minnesota | $168.46 | $80.48 |
How the 40808 rate is calculated
Each of 40808’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 · 40808
RVUs × geographic indexes × conversion factor
Work1.02
1.02 RVUs× 1.000 GPCI
Practice expense3.87
3.87 RVUs× 1.000 GPCI
Malpractice0.14
0.14 RVUs× 1.000 GPCI
Adjusted RVUs
5.0300
Conversion factor
$33.4009
Medicare rate
$168.01
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 40808
40808 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 40808
Mouth biopsy
| 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 · 40808
Mouth biopsy
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
40808 without 51 · national office
$168.01
Mouth biopsy
40808-51 · Second procedure: 50%
$84.01
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%).
40808 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 40810Mouth lesion excision
- Use 40808 when tissue is sampled from a vestibular lesion. Use 40810 when the clinician excises the lesion rather than taking a biopsy.
- 40490Lip biopsy
- Both describe oral-site biopsies, but 40490 is for a lesion of the lip; 40808 is for the oral vestibule.
- 41100Tongue biopsy
- 41100 is for a tongue biopsy. Choose 40808 when the sampled lesion is in the vestibule between the lips or cheeks and the teeth and gums.
40808 billing questions
How is 40808 different from 40810?
40808 is for tissue sampling of a vestibular lesion. Choose an excision code such as 40810 when the service removes the lesion rather than taking a biopsy sample.
Can the pathology examination be billed separately?
The biopsy code represents the clinician’s tissue-sampling procedure. The laboratory or pathologist may separately report the appropriate examination of the submitted specimen.
Should modifier 50 be appended for lesions on both sides?
No. CMS identifies bilateral adjustment as inappropriate for 40808; modifier 50 should not be used for this service.
Are related follow-up visits included?
Yes. The code has a 10-day global period, which includes related postoperative visits during that period.
Can an assistant surgeon or co-surgeon be reported?
Medicare does not pay an assistant at surgery for 40808. 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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