CPT 41826 Reimbursement & Benchmarks | OpenPayer

Summary & Overview

CPT 41826: Excision of Dentoalveolar Tumor or Lesion, Simple Repair

CPT code 41826 identifies the surgical excision of a tumor or lesion arising from dentoalveolar structures with a simple repair of the resultant site. This code is used for localized oral surgical procedures that remove pathological tissue from tooth-supporting areas and close the defect with straightforward techniques. Nationally, accurate coding for dentoalveolar lesion excision matters for clinical documentation, appropriate payment, and tracking of oral surgical care patterns.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a national perspective on billing and clinical context rather than state-specific rules.

Readers will find: concise clinical context for when 41826 applies; typical sites of service and service type; common payer coverage considerations and the list of payers included in the analysis; and what to expect in related billing practice such as typical modifiers and related coding areas (where available). Data not available in the input is noted where relevant, and the piece focuses on clarifying the code's clinical meaning and administrative implications for national stakeholders including payers, providers, and billing teams.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare41826CPToral-surgerydentoalveolarlesion-excisionsurgical-repairambulatory-surgerydental-coding

Billing Code Overview

CPT code 41826 describes the excision of a tumor or lesion from a dentoalveolar structure with a simple repair of the site. This procedure involves removal of a localized oral lesion originating in the tooth-supporting (dentoalveolar) tissues and straightforward closure of the defect.

Service type: Surgical excision of dentoalveolar tumor/lesion with simple repair
Typical site of service: Dental or oral surgery setting, ambulatory surgery center, or hospital outpatient department

Clinical & Coding Specifications

Clinical Context

A 52-year-old patient presents to an oral and maxillofacial surgery clinic with a 1.2 cm, well-circumscribed soft tissue lesion located on the buccal mucosa adjacent to a partially erupted molar. The lesion is suspicious for a benign odontogenic or mucosal tumor based on clinical exam and imaging and is symptomatic with intermittent pain and local irritation during mastication. After informed consent, the patient is taken to an ambulatory procedure suite. Under local anesthesia with sedation, the surgeon performs an excision of the lesion involving the dentoalveolar structures, ensuring removal of involved tissue margins, and performs a simple repair of the site with interrupted sutures. The specimen is submitted for histopathology. Postoperative instructions are provided and a short interval follow-up is scheduled for suture removal and wound assessment.

Typical workflow steps:

Preoperative evaluation and medical clearance when indicated
Local anesthesia with or without monitored anesthesia care
Excision of the tumor/lesion from dentoalveolar tissue
Simple closure/repair of surgical site
Specimen submission to pathology
Immediate postoperative recovery and discharge from ambulatory setting

Typical site of service: outpatient ambulatory surgery center or dental/oral surgery clinic.

Service type: minor oral surgical procedure (excision with simple repair) performed by oral and maxillofacial surgeons, oral surgeons, or dental specialists.

Coding Specifications

CPT 41850: Dentoalveolar Lesion Destruction, Non-Excisional

CPT-41825-DENTOALVEOLAR-LESION-EXCISION-NO-REPAIR

CPT 41825: Excision of Dentoalveolar Lesion Without Repair

CPT-41823-DENTOALVEOLAR-BONE-RESECTION

CPT 41823: Dentoalveolar Bone Resection

CPT-41821-OPERCULECTOMY-DENTAL-MINOR-ORAL-SURGERY

CPT 41821: Operculectomy, Excision of Operculum

CPT-41822-DENTOALVEOLAR-TUBEROSITY-FIBROUS-TISSUE-EXCISION

CPT 41822: Excision of Fibrous Soft Tissue Over Dentoalveolar Tuberosity

CPT-41820-PERIODONTAL-GUM-SEPARATION-FOR-INFECTION-TREATMENT

CPT 41820: Periodontal Gingival Separation for Infection Treatment

CPT-41828-ALVEOLAR-MUCOSA-EXCISION-SINGLE-QUADRANT

CPT 41828: Excision of Hyperplastic Alveolar Mucosa, Single Quadrant

CPT-41830-ALVEOLAR-PROCESS-BONE-REMOVAL

CPT 41830: Removal of Alveolar Process Including Inflamed or Dead Bone

CPT-41827-DENTOALVEOLAR-LESION-EXCISION-COMPLEX-REPAIR

CPT 41827: Dentoalveolar Lesion Excision with Complex Repair

Modifier	Description	When to Use
`22`	Increased procedural services	When work required is substantially greater than typical for the procedure (e.g., extensive dissection for access).
`23`	Unusual anesthesia	When procedure is performed under general anesthesia or deep sedation unexpected for the procedure.
`26`	Professional component	When billing separately for the professional component of a diagnostic service (rare for this code).
`52`	Reduced services	When the procedure is partially reduced or not completed as originally planned.
`59`	Distinct procedural service	When another unrelated procedure is performed in a separate anatomic site during the same encounter.
`62`	Two surgeons	When two surgeons work together as primary surgeons performing distinct portions of the procedure.
`78`	Unplanned return to OR	When the patient requires an unplanned return to the operating room for a related procedure during the global period.
`80`	Assistant surgeon	When a surgical assistant performs a portion of the operation.
`81`	Minimum assistant surgeon	When a minimal assistant surgeon is required.
`82`	Assistant surgeon (when qualified resident not available)	When an assistant surgeon is used because a qualified resident is not available.
`LT`	Left side	To designate left anatomic site when laterality is reportable.
`RT`	Right side	To designate right anatomic site when laterality is reportable.
`TC`	Technical component	When only the technical component of a service is reported (rare for excisional procedures).
`AS`	Ambulatory surgical center facility service	To identify facility reimbursement when performed in an ASC.

Taxonomy Code	Specialty	Notes
1223P0001X	Oral and Maxillofacial Surgery	Primary specialty performing dentoalveolar excisions.
1223P0800X	Oral Surgery	Dental specialty that frequently performs intraoral tumor excisions.
1223P0700X	General Dentistry	General dentists with surgical training may perform minor excisions in-office.
103K00000X	Otolaryngology	Otolaryngologists may perform oral cavity or alveolar region excisions when indicated.
207L00000X	Plastic Surgery	Reconstructive surgeons may be involved for complex closures or larger defects.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K09.8`	Other cysts of oral region, not elsewhere classified	Cysts in dentoalveolar regions may require excision and simple repair.
`K08.4`	Retained dental root	Surgical removal of root fragments in alveolus can be associated with simple reparative closure.
`K06.8`	Other specified disorders of gingiva and edentulous alveolar ridge	Lesions of the alveolar ridge requiring excision fall under this category.
`C07.9`	Malignant neoplasm of parotid gland, unspecified	While major salivary malignancies often require more extensive surgery, small localized lesions in adjacent dentoalveolar areas could be evaluated for excision.
`D22.9`	Melanocytic nevi of skin and mucous membrane, unspecified	Pigmented mucosal lesions may be excised for diagnosis and treatment.
`K11.6`	Disturbances of salivary secretion	Salivary gland lesions near dentoalveolar structures may present for excision.
`L98.9`	Disorder of skin and subcutaneous tissue, unspecified	Non-specific mucocutaneous lesions of the oral cavity that require removal and simple repair.
`R68.89`	Other general symptoms and signs	Non-specific symptoms (pain, swelling) that prompt evaluation and excision when a lesion is identified.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`41826`	Excision of tumor or lesion of dentoalveolar structures; simple repair	Primary procedural code describing excision with simple repair of a dentoalveolar lesion.
`40806`	Excision of benign lesion of lip; simple repair	Similar minor oral soft tissue excision when the lesion involves the lip rather than dentoalveolar structures; alternative code for perioral lesions.
`40490`	Biopsy of oral mucosa; single lesion	Diagnostic biopsy code used when a limited diagnostic biopsy is performed instead of full excision.
`41010`	Excision of lesion of hard palate, maxillary alveolus or other intraoral sites; simple repair	Related intraoral excision code for lesions located on the maxillary alveolus or hard palate.
`12001`	Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities; 2.5 cm or less	Common simple repair CPT family; provides context for closure complexity though not an intraoral-specific code.
`99024`	Postoperative follow-up visit, normally included in surgical package	Represents routine postoperative care included in the global surgical package following `41826`.

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