Surgical · Other

Surgical removal of a benign tumor or cyst from the mandible by enucleation and/or curettage, without osteotomy.

Verified May 8, 2026 · 6 sources ↓

Medicare: $479.97
Total RVUs: 14.37
Global, days: 90
Region: Other

Drawn from AAPCAaomsEmednyMdclarityCMS

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 6 cited references ↓

Operative note must state enucleation and/or curettage as the technique — 'excision' alone is insufficient
Explicitly document absence of osteotomy; if bone was cut, a higher-level code applies
Pathology report confirming benign diagnosis — hold claim submission until received
Lesion characteristics: size, location within mandible, and whether cystic or solid
If a same-day E/M is billed, document the separately identifiable medical issue distinct from the lesion

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 25 Significant separate E/M 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 21040 covers enucleation and/or curettage of a benign lesion — typically a cyst or benign tumor — from the mandible. The defining boundary is the absence of an osteotomy. If your surgeon cut bone to access or remove the lesion, you're in 21046 (intra-oral osteotomy) or 21047 (extra-oral osteotomy with partial mandibulectomy) territory, both of which carry significantly higher RVUs. Misassigning 21040 when an osteotomy was performed is the most common underreporting error on mandibular excision claims.

For malignant lesions, 21040 does not apply — use 21044 for standard resection or 21045 for radical resection. The benign-versus-malignant distinction must be confirmed by pathology before final claim submission; AAOMS guidance recommends holding the claim until the pathology report is in hand. When bone grafting is performed in conjunction with a more extensive resection (21045 or 21047), report 21215 separately for the graft.

The 90-day global period means post-op visits, wound checks, and suture removals through day 90 are bundled. A same-day E/M for a separately identifiable medical problem (e.g., workup of a systemic condition affecting surgical risk) requires modifier 25 on the E/M. Local anesthesia is always considered inherent and is never billed separately.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	4.79
Practice expense RVU	8.99
Malpractice RVU	0.59
Total RVU	14.37
Medicare national rate	$479.97
Global period	90 days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$479.97
HOPD (APC 5164) Hospital outpatient department	$3,387.27
ASC (PI A2) Ambulatory surgical center (freestanding)	$1,480.50

Common denial reasons

The recurring reasons claims for CPT 21040 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Claim submitted before pathology report confirms benign nature, leading to diagnosis-code mismatch
Operative note documents an osteotomy, making 21040 incorrect — payers audit up-coding and down-coding alike
E/M billed same-day without modifier 25, triggering NCCI bundling denial
Post-op visit billed separately within the 90-day global period without modifier 24 or 79
Bilateral claim submitted without modifier 50, resulting in duplicate-procedure denial

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01What separates 21040 from 21046?

The osteotomy. 21040 is enucleation or curettage only — no bone cutting. 21046 applies when an intra-oral osteotomy was required to access or remove the lesion. The RVU gap between them is substantial; always check the operative note for any mention of osteotomy before assigning 21040.

02Can 21040 be billed for a malignant mandibular lesion?

No. 21040 is limited to benign tumors and cysts. Use 21044 for standard resection of a malignant mandibular tumor, or 21045 for radical resection. Confirm with pathology before submitting.

03Should I hold the claim until pathology results are back?

Yes. AAOMS guidance is explicit: delay submission until the pathology report confirms the diagnosis. Submitting with a presumptive benign diagnosis that pathology later revises to malignant creates a coding error that requires a corrected claim.

04Is bone grafting bundled into 21040?

Bone grafting is not a component of 21040-level work. If grafting is performed — which is more common with the higher-level resection codes — report 21215 separately. At the 21040 level (simple enucleation/curettage), grafting is uncommon, but if performed, document it thoroughly and append modifier 59 or 51 as appropriate.

05How do I bill a same-day E/M with 21040?

Append modifier 25 to the E/M code, not to 21040. The E/M must reflect a separately identifiable service — for example, evaluation of a systemic condition like diabetes that could affect surgical management. Document that work distinctly in the note.

06Does the 90-day global period apply to 21040?

Yes. All routine post-op care through day 90 is bundled. To bill a post-op visit for an unrelated condition, use modifier 24 on the E/M. For an unrelated procedure performed during the global period, use modifier 79.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

Mira's AI scribe captures the surgical technique (enucleation vs. curettage), explicit confirmation that no osteotomy was performed, lesion location within the mandible, and the pre-op working diagnosis versus post-op pathology status. This prevents the two most common audit flags: miscoding to 21046/21047 when no osteotomy occurred, and premature claim submission before pathology confirms the benign diagnosis.

See how Mira captures CPT 21040 documentation