CPT code 40801: Mouth drainage, complicated vestibular collection2026 Medicare rate & RVUs

Medicare pays $307.29 for 40801 nationally in the office and $189.38 in a hospital or facility. Local office rates run $272.11–$404.43.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 40801 covers

This service treats a fluid collection such as an abscess, cyst, or hematoma in the vestibule—the space between the lips or cheeks and the teeth or gums. An oral and maxillofacial surgeon, dentist, or otolaryngologist may incise the site and evacuate the collection in an office or facility setting. The clinical purpose is drainage, not tissue sampling or removal of the lesion.

Select this code when the documented procedure meets the complicated level, rather than the simpler drainage represented by 40800. The operative note should identify the collection and vestibular site and describe the incision and drainage performed, with details supporting the level selected. Related postoperative visits during the 10-day global period are included. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service; co-surgeons and team surgery are not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 40801 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

40801 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 40801 rate is calculated

Each of 40801’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 40801

40801 has a 10-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 51

40801 compared with similar codes

How to choose

40800Oral drainageSimple vestibular drainage

Use 40801 for complicated vestibular drainage and 40800 for the simpler drainage level. The procedure note should support the distinction.

40808Mouth biopsyOral vestibule

40808 is for biopsy of a mouth lesion. Choose it when tissue is sampled, rather than when a collection is incised and evacuated.

40810Mouth lesion excisionWithout repair

40810 describes excision of a mouth lesion. It is appropriate when the lesion is removed, not merely drained.

40820Oral lesion treatmentWithout repair

40820 is for treatment of a mouth lesion by a different treatment approach; 40801 specifically represents complicated drainage of a vestibular collection.

Codes related to 40801

Related codes aren’t interchangeable: bill the code that matches the service performed.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates