How much does Medicare pay for CPT 40808?

Medicare allowed an average of $131.35 per service and paid $99.20 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $523.20, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 40808?

Biopsy of mouth. It was billed 1,166 times to 1,001 Medicare beneficiaries by 56 providers in 2024.

Does 40808 pay differently in an office than a hospital?

Yes. The allowed amount averaged $141.47 in an office setting and $86.83 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 40808 most?

Oral Surgery (Dentist only), with 366 services from 17 clinicians. Next are Maxillofacial Surgery, Otolaryngology, Pathology.

CPT 40808

Biopsy of mouth

$131.35Medicare-allowed amount per service, averaged across 1,166 services

Providers submitted

$523.20

Asking price, not received

Medicare allowed

$131.35

The fee schedule figure

Medicare paid

$99.20

Balance is patient coinsurance

Providers submitted an average of $523.20 for this code and Medicare allowed $131.35 — 4.0× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $99.20 (76%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $141.47
Hospital / facility: $86.83

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 950 services were billed in an office setting and 216 in a facility.

Services: 1,166
Beneficiaries: 1,001
Providers billing it: 56
Total allowed: $153,154

What Medicare pays for CPT 40808

Across 1,166 services billed by 56 providers to 1,001 beneficiaries, Medicare allowed an average of $131.35 per service. That is 1.2 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 40808

Specialty	Services	Beneficiaries	Avg allowed	Providers
Oral Surgery (Dentist only)	366	304	$136.71	17
Maxillofacial Surgery	262	229	$139.78	15
Otolaryngology	203	184	$119.33	12
Pathology	114	96	$141.59	2
Dentist	80	73	$105.39	5
Oral and Maxillofacial Pathology	62	49	$135.26	1
Dermatology	46	37	$147.19	2
Plastic and Reconstructive Surgery	17	15	$82.80	1
Nurse Practitioner	16	14	$70.92	1

40808 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
Ohio	188	$140.82	$105.69	4
California	157	$139.59	$76.22	5
Arizona	112	$108.09	$85.74	4
New York	98	$123.14	$78.55	5
Pennsylvania	72	$91.98	$62.31	4
Texas	64	$102.01	$77.32	4
Massachusetts	45	$145.93	$98.73	3
New Jersey	45	$175.59	$119.38	2
Minnesota	41	$155.79	$112.55	3
Florida	35	$162.01	$127.57	2
North Carolina	33	$145.33	$121.37	2
Illinois	30	$93.51	$67.59	2
Utah	27	$142.90	$101.71	1
Wisconsin	23	$70.38	$42.82	1
Alaska	22	$179.54	$117.73	1
Nevada	17	$82.80	$66.22	1
Maryland	17	$161.61	$112.52	1
Michigan	16	$70.92	$52.90	1
New Hampshire	15	$97.36	$70.05	1
Delaware	13	$153.43	$95.79	1
Georgia	13	$152.64	$118.27	1
Arkansas	13	$146.47	$132.60	1
West Virginia	12	$161.75	$127.21	1
Indiana	12	$134.74	$121.91	1
District of Columbia	12	$185.84	$131.02	1
Colorado	12	$173.62	$132.37	1
Louisiana	11	$151.46	$122.17	1
Virginia	11	$155.76	$117.92	1

Related codes

40812Removal of growth of mouth$186.01
40820Destruction of growth or scar of mouth$282.31

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.