$294.18–$325.25
Both address mouth vestibule lacerations; choose 40830 for a simple repair and 40831 when the repair is complicated.
On this page
CMS RVU26D · Effective 2026-10-01
40830 Mouth laceration repair Medicare reimbursement rates in Pennsylvania
Report this code for simple repair of a traumatic laceration in the mouth vestibule, such as a cut along the inner lip or cheek. Compare 40830 office and facility rates across CMS payment localities in Pennsylvania.
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 40830 in Pennsylvania?
Pennsylvania 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
$217.85–$241.11
2 of 2 localities have a supported rate.
Facility setting
$132.30–$144.10
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 40830: Simple oral vestibule laceration repair
Report this code for simple repair of a traumatic laceration in the mouth vestibule, such as a cut along the inner lip or cheek.
This code describes simple repair of a traumatic cut in the oral vestibule—the space between the inner lip or cheek and the teeth or gums. A clinician may use it for an uncomplicated mucosal laceration, such as one caused by a fall or impact. Oral and maxillofacial surgeons, dentists, otolaryngologists, and emergency clinicians may perform the repair in an office, emergency department, or operating room. The key distinction from 40831 is that 40830 is for a simple repair; the record should identify the wound’s location and describe the repair performed.
Report one unit for the repair and document the injury, vestibular site, and basis for selecting the simple repair code. Medicare 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 multiple-procedure reduction. Modifier 50 is inappropriate for this descriptor and anatomy. Assistant-at-surgery payment requires documentation of medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 40830
- 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
- Assistant at surgery is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU1.77 · 26%
- Practice expense (office) RVU4.94 · 71%
- Malpractice RVU0.23 · 3%
463
Medicare services in 2024 · #3629 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.
40830 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
$264.76–$292.46
40812 describes excision of a mouth lesion with repair. 40830 is for repair of a traumatic laceration, without lesion excision as the service.
$157.15–$174.82
40808 is for biopsy of a mouth lesion. It is not a repair code for a traumatic vestibular cut.
Compare 40830 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 Philadelphia →
Office / nonfacility
$241.11
Facility
$144.10
Rest Of Pennsylvania →
Office / nonfacility
$217.85
Facility
$132.30
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40830 billing questions
How does 40830 differ from 40831?
40830 is for simple repair of a laceration in the mouth vestibule. Use 40831 when the repair is documented as complicated.
Can this code be used for a mouth lesion that is excised?
No. This code describes repair of a traumatic laceration. Lesion excision with repair is represented by lesion-specific codes such as 40812 or 40814, as appropriate.
Are related postoperative visits separately reported?
Related postoperative visits during the 10-day global period are included in the procedure.
Should modifier 50 be appended for wounds on both sides of the mouth?
No. Modifier 50 is inappropriate for this descriptor and anatomy; report the repair without a bilateral adjustment.
When is an assistant-at-surgery payable?
Medicare pays an assistant at surgery only when the record documents medical necessity. 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 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.
4,86740818,,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
4,87340842,,Reconstruction of mouth,R,,8.92,14.84,,6.05,,1.33,25.09,16.30,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00