CPT 40812 Surgery - Digestive
Excise/repair mouth lesion Cost
Body System: Digestive
Medicare Facility Rate
$168
CMS PFS CY2026
Medicare Non-Facility Rate
$281
Office/clinic setting
Hospital Outpatient
$1
OPPS rate
Surgery Center (ASC)
$195
ASC rate
Relative Value Units (RVUs)
Medicare payment = Total RVU × Conversion Factor ($33.40 for CY 2026)
2.31
Work RVU
2.44
Facility PE RVU
0.29
Malpractice RVU
8.42
Total RVU
Frequently Asked Questions
How much does Excise/repair mouth lesion cost?
The Medicare facility rate is $168. Commercial insurance typically pays 150-250% of Medicare rates (varies). Hospital outpatient rate: $1. Ambulatory surgery center rate: $195.
How much does Excise/repair mouth lesion cost without insurance?
Without insurance, you may pay the hospital's chargemaster rate, which is often 300-500% of Medicare. Ask about cash-pay discounts — many facilities offer 20-40% off for self-pay patients. The Medicare baseline for this procedure is $168.