2025 CPT code 40812
(Active) Effective Date: N/A Revision Date: N/A Surgery - Oral Mucosa Procedures Digestive System Feed
Excision of a lesion from the mucosa and submucosa of the mouth's vestibule; includes simple repair.
Modifiers may be applicable in certain circumstances (e.g., 51 for multiple procedures, 25 for significant, separately identifiable E/M service by the same physician on the same day). Consult the CPT manual for more details.
The medical necessity for this procedure is established by the presence of a lesion in the vestibule of the mouth that requires excision for diagnostic or therapeutic reasons (e.g., pain, functional impairment, cosmetic concerns, suspected malignancy).Documentation should clearly justify the need for the intervention.
The clinical responsibility involves the preparation and anesthetization of the patient. The provider then makes an incision to remove the lesion with its margins and closes the superficial defect with simple interrupted sutures. The procedure requires surgical expertise in oral cavity procedures and wound repair.
In simple words: The doctor removes a piece of damaged tissue from the inside of the cheek or lip area near the teeth.The small cut is then stitched closed.
This CPT code, 40812, encompasses the surgical excision of a lesion (damaged or diseased tissue) located in the mucosa and/or submucosa of the mouth's vestibule.The vestibule is the area between the lips and cheeks and the teeth and gums. The procedure includes a simple repair of the surgical wound using one layer of interrupted sutures.Local anesthesia is typically included.
Example 1: A patient presents with a small, benign fibroma on the inner surface of their lower lip (vestibule). The physician excises the lesion and performs a simple closure., A patient experiences a minor trauma to the buccal mucosa near the molars, resulting in a small laceration and minor tissue damage. The physician cleans the wound, excises the damaged tissue and closes the wound with simple sutures., A patient has a small cyst in the vestibule of their mouth causing discomfort. The physician excises the cyst and performs a simple closure.
* Detailed operative report describing the location, size, and nature of the lesion.* Type and number of sutures used for closure.* Pathology report confirming the nature of the excised tissue.* Preoperative and postoperative photographs if available.* Anesthesia record.
** Always verify the complexity of the repair before selecting the appropriate code. If the repair is more complex than a simple closure, use a different code.
- Revenue Code: P6C (Medicare Fee Schedule: MINOR PROCEDURES - OTHER)
- RVU: This information is not available in the provided source.Consult the current Medicare Physician Fee Schedule for RVU values and reimbursement rates.
- Global Days: The global period for this procedure is not explicitly defined in the source.Refer to payer-specific guidelines or local practice for details.
- Payment Status: Active
- Modifier TC rule: This code does not have a technical component (TC) modifier.The entire service is reported with one code.
- Fee Schedule: This information is not available in the provided source. Consult historical fee schedules from relevant payers for this information.
- Specialties:Oral and Maxillofacial Surgery, Dentistry
- Place of Service:Office, Ambulatory Surgical Center, Hospital Outpatient Department