$164.40
40808 reports biopsy of a mouth lesion. Use 40818 when the oral mucosa is harvested to serve as donor graft tissue.
On this page
CMS RVU26D · Effective 2026-10-01
40818 Oral graft harvest Medicare reimbursement rates in Vermont
Reports harvesting oral mucosa from the mouth vestibule for use as a graft during reconstructive surgery, such as urethral reconstruction. Compare 40818 office and facility rates across CMS payment localities in Vermont.
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 40818 in Vermont?
Vermont has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$356.02
1 of 1 localities have a supported rate.
Payment area: Vermont
One mapped payment locality.
Facility setting
$239.30
1 of 1 localities have a supported rate.
Payment area: Vermont
One mapped payment locality.
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 40818: Oral mucosa graft harvest
Reports harvesting oral mucosa from the mouth vestibule for use as a graft during reconstructive surgery, such as urethral reconstruction.
This service removes oral mucosa from the vestibule of the mouth to provide donor tissue for reconstruction at another site. It is performed by a surgeon, often an oral and maxillofacial surgeon, otolaryngologist, or urologist, when a reconstructive procedure calls for oral mucosal graft tissue. A familiar clinical use is harvesting buccal mucosa for urethral reconstruction. The code represents the donor-site harvest, not removal of a mouth lesion or the reconstruction at the recipient site.
Report the harvest when the operative note identifies the oral donor site, the tissue obtained, and its graft purpose; report the recipient-site procedure separately when performed and supported. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur 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 code. Assistant-at-surgery payment requires documented medical necessity; co-surgeon and team-surgery billing are not permitted.
CMS billing rules for 40818
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care 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 RVU2.76 · 25%
- Practice expense (office) RVU7.80 · 71%
- Malpractice RVU0.35 · 3%
142
Medicare services in 2024 · #4604 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.
40818 compared with similar codes
Office rates for Vermont, from the same CMS release.
$211.48
40810 is for excising a mouth lesion, not obtaining tissue for grafting. The operative purpose distinguishes the services.
$274.51
40812 addresses lesion excision with repair; 40818 describes harvesting oral mucosa for use as a graft at another site.
Compare 40818 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.
1 of 1 payment localities
Vermont →
Office / nonfacility
$356.02
Facility
$239.30
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 40818 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
4,867
- Code
- 40818
- Physician work
- 2.76
- Practice expense
- 7.80
- Malpractice
- 0.35
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.76 | × 1.000 | 2.7600 |
| Practice expense | 7.80 | × 0.990 | 7.7220 |
| Malpractice | 0.35 | × 0.506 | 0.1771 |
| Total RVUs | 10.6591 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Vermont$356.02
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.76 | 1 |
| Practice expense | 7.8 | 0.99 |
| Malpractice | 0.35 | 0.506 |
(2.76 × 1 + 7.8 × 0.99 + 0.35 × 0.506) × $33.4009 = $356.02
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.76 | 1 |
| Practice expense | 4.27 | 0.99 |
| Malpractice | 0.35 | 0.506 |
(2.76 × 1 + 4.27 × 0.99 + 0.35 × 0.506) × $33.4009 = $239.30
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
40818 billing questions
How is graft harvest different from excising a mouth lesion?
This code is for taking oral mucosa as donor tissue for grafting. Lesion-excision codes apply when the purpose is removal of a lesion, with code selection based on the service performed.
Can the recipient-site reconstruction be reported separately?
Yes, when a distinct recipient-site procedure is performed and documented. For example, oral mucosa may be harvested for a urethral reconstruction, with the reconstruction reported under its applicable code.
Does modifier 50 apply when mucosa is harvested from both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code, so modifier 50 should not be used.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
When is an assistant at surgery payable?
Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeon and team-surgery billing 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.
4,86440812,,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
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
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817