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

Reports incision and drainage of a complicated abscess, cyst, or hematoma in the vestibule of the mouth, rather than simple drainage.

CMS RVU26DEffective Oct 1, 2026One payment locality418 Medicare services in 2024

In Utah, Medicare pays $293.50 for 40801 in the office and $182.67 when it’s performed in a hospital or facility.

$293.50Office (non-facility)
$182.67Hospital or facility
−4.5%vs the national office rate ($307.29)

Check a contract rate as a % of Medicare · 40801 nationwide

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

We’ll open 40801 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Utah
  2. What 40801 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

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.

How Utah compares for 40801

Across 109 of 109 payment localities, the office rate for 40801 runs from $272.11 in Arkansas to $404.43 in San Benito County, CA. Utah pays $293.50. The RVUs are the same everywhere; the geographic indexes change the dollars.

40801 in Utah vs other payment areas
  1. Utah · this page$293.50
  2. Los Angeles, CA · California$345.49+$51.99
  3. Washington, DC area · District of Columbia$350.64+$57.14
  4. Miami, FL · Florida$333.28+$39.78
  5. Chicago, IL · Illinois$323.65+$30.15
  6. Manhattan, NY · New York$353.50+$60.00
  7. Alaska · Alaska$358.62+$65.12

Other areas in Utah first, then benchmark localities. Bars start at $0.

Every other payment area

40801 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$276.06$172.89
ArkansasArkansas$272.11$170.83
ArizonaArizona$299.13$184.88
Bakersfield, CACalifornia$324.67$195.45
Chico, CACalifornia$323.67$194.45
El Centro, CACalifornia$323.73$194.51
Fresno, CACalifornia$323.67$194.45
Hanford, CACalifornia$323.67$194.45

40801 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$272.11

$364.05

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
40801 office rate range by state
State / territoryOffice rate rangeLocalities
AK$358.621
AL$276.061
AR$272.111
AZ$299.131
CA$323.67–$404.4329
CO$319.291
CT$327.591
DC$350.641
DE$304.041
FL$303.74–$333.283
GA$286.74–$313.192
GU$331.341
HI$331.341
IA$282.551
ID$284.471
IL$295.37–$323.654
IN$286.091
KS$281.451
KY$282.971
LA$282.61–$296.422
MA$317.50–$350.372
MD$309.74–$350.643
ME$286.16–$301.202
MI$290.45–$307.712
MN$305.401
MO$277.95–$297.213
MS$275.081
MT$307.271
NC$289.091
ND$300.541
NE$284.021
NH$314.501
NJ$331.17–$347.122
NM$292.111
NV$305.601
NY$293.39–$362.265
OH$289.071
OK$282.241
OR$303.07–$329.112
PA$289.41–$319.652
PR$309.431
RI$314.631
SC$289.591
SD$299.751
TN$282.881
TX$287.54–$318.378
UT$293.501
VA$300.37–$350.642
VI$309.431
VT$299.571
WA$316.84–$357.252
WI$290.591
WV$284.621
WY$304.341

See 40801 in every payment locality

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.

How the rate is built · 40801

RVUs × geographic indexes × conversion factor

Office or facility?

Work2.56

2.56 RVUs× 1.000 GPCI

Practice expense6.30

6.30 RVUs× 1.000 GPCI

Malpractice0.34

0.34 RVUs× 1.000 GPCI

Adjusted RVUs

9.2000

Conversion factor

$33.4009

Medicare rate

$307.29

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Utah inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

4,858

Code
40801
Physician work
2.56
Practice expense
6.30
Malpractice
0.34

GPCI2026.csv

104

Locality
Utah
Physician work
1.000
Practice expense
0.940
Malpractice
0.898
Office calculation for 40801 in Utah
ComponentRVULocality factorAdjusted
Physician work2.56× 1.0002.5600
Practice expense6.30× 0.9405.9220
Malpractice0.34× 0.8980.3053
Total RVUs8.7873
Conversion factor× 33.4009

Office rate, Utah$293.50

Office: (2.56 × 1 + 6.3 × 0.94 + 0.34 × 0.898) × $33.4009 = $293.50

Facility: (2.56 × 1 + 2.77 × 0.94 + 0.34 × 0.898) × $33.4009 = $182.67

Open 40801 in the RVU calculator

Payment rules and modifiers for 40801

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

CMS payment indicators · 40801

Mouth drainage, complicated vestibular collection

RuleCMS valueWhat it means
Global period010Minor procedure: the day of the procedure plus 10 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.80/0.10Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 40801

Mouth drainage, complicated vestibular collection

10-day global period ends

Oct 11, 2026

Covers Oct 1, 2026 through Oct 11, 2026 (11 days).

Visit on Oct 31, 2026

After the global period ends: visits and procedures are billed normally.

SurgeryVisit
Sep 28, 2026Oct 14, 2026

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

40801 without 51 · national office

$307.29

Mouth drainage, complicated vestibular collection

40801-51 · Second procedure: 50%

$153.65

When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).

When to use modifier 51

Codes related to 40801

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

Codes related to 40801
CodeHow it relatesOffice range, Utah
Same family
40800Oral drainage, simple vestibular drainageRelated simpler drainage service for a mouth collection.$199.35
Used instead
40808Mouth biopsy, oral vestibuleUsed for tissue sampling when diagnosis, rather than drainage, is the purpose.$159.77
40810Mouth lesion excision, without repairUsed when a mouth lesion is excised rather than drained.$205.55
40820Oral lesion treatment, without repairDescribes treatment of a mouth lesion by a method other than drainage.$239.46

How 40801 has changed in Utah

40801 · Office / nonfacility

$293.50

Effective 2026-10-01

The base rate is $19.84 higher than on 2025-10-01, moving from $273.66 to $293.50 (7.2%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $273.66changed to$293.50

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.63 changed to 2.56
    • Practice expense RVU 5.97 changed to 6.30
    • Malpractice RVU 0.28 changed to 0.34
    • Practice expense GPCI 0.933 changed to 0.940
    • Malpractice GPCI 0.930 changed to 0.898

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $278.21changed to$273.66

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 5.87 changed to 5.97
    • Malpractice RVU 0.27 changed to 0.28

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $273.67changed to$278.21

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $279.06changed to$273.67

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 5.81 changed to 5.87
    • Malpractice RVU 0.26 changed to 0.27
    • Practice expense GPCI 0.926 changed to 0.933
    • Malpractice GPCI 0.865 changed to 0.930

  5. January 1, 2023

    RVU23A

    $280.79changed to$279.06

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 5.75 changed to 5.81
    • Malpractice RVU 0.25 changed to 0.26
    • Practice expense GPCI 0.919 changed to 0.926
    • Malpractice GPCI 0.799 changed to 0.865

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $287.29changed to$280.79

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 5.88 changed to 5.75

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $294.00changed to$287.29

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 5.70 changed to 5.88
    • Malpractice RVU 0.26 changed to 0.25
    • Practice expense GPCI 0.923 changed to 0.919
    • Malpractice GPCI 0.982 changed to 0.799

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $306.60changed to$294.00

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 5.80 changed to 5.70
    • Malpractice RVU 0.43 changed to 0.26
    • Practice expense GPCI 0.927 changed to 0.923
    • Malpractice GPCI 1.165 changed to 0.982

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $311.36changed to$306.60

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 5.94 changed to 5.80
    • Malpractice RVU 0.44 changed to 0.43

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $313.99changed to$311.36

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 6.06 changed to 5.94
    • Practice expense GPCI 0.925 changed to 0.927
    • Malpractice GPCI 1.167 changed to 1.165

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $315.60changed to$313.99

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 6.15 changed to 6.06
    • Practice expense GPCI 0.922 changed to 0.925
    • Malpractice GPCI 1.169 changed to 1.167

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $317.40changed to$315.60

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 6.17 changed to 6.15

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $315.82changed to$317.40

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $310.59changed to$315.82

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 6.14 changed to 6.17
    • Malpractice RVU 0.35 changed to 0.44
    • Practice expense GPCI 0.919 changed to 0.922
    • Malpractice GPCI 1.136 changed to 1.169

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $312.16changed to$310.59

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 6.70 changed to 6.14
    • Malpractice RVU 0.37 changed to 0.35
    • Practice expense GPCI 0.916 changed to 0.919
    • Malpractice GPCI 1.102 changed to 1.136

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $312.16

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$293.50$182.67RVU26D
2026-07-01$293.50$182.67RVU26C
2026-04-01$293.50$182.67RVU26B
2026-01-01$293.50$182.67RVU26A
2025-10-01$273.66$190.37RVU25D
2025-07-01$273.66$190.37RVU25C
2025-04-01$273.66$190.37RVU25B
2025-01-01$273.66$190.37RVU25A
2024-10-01$278.21$191.56RVU24D
2024-07-01$278.21$191.56RVU24C
2024-04-01$278.21$191.56RVU24B
2024-03-09$278.21$191.56RVU24AR
2024-01-01$273.67$188.43RVU24A
2023-10-01$279.06$190.88RVU23D
2023-07-01$279.06$190.88RVU23C
2023-04-01$279.06$190.88RVU23B
2023-01-01$279.06$190.88RVU23A
2022-10-01$280.79$190.47RVU22D
2022-07-01$280.79$190.47RVU22C
2022-04-01$280.79$190.47RVU22B
2022-01-01$280.79$190.47RVU22A
2021-10-01$287.29$193.98RVU21D
2021-07-01$287.29$193.98RVU21C
2021-04-01$287.29$193.98RVU21B
2021-01-01$287.29$193.98RVU21A
2020-10-01$294.00$206.39RVU20D
2020-07-01$294.00$206.39RVU20C
2020-04-01$294.00$206.39RVU20B
2020-01-01$294.00$206.39RVU20A
2019-10-01$306.60$219.74RVU19D
2019-07-01$306.60$219.74RVU19C
2019-04-01$306.60$219.74RVU19B
2019-01-01$306.60$219.74RVU19A
2018-10-01$311.36$225.26RVU18D
2018-07-01$311.36$225.26RVU18C
2018-04-01$311.36$225.26RVU18B
2018-01-01$311.36$225.26RVU18AR1
2017-10-01$313.99$227.01RVU17D
2017-07-01$313.99$227.01RVU17C
2017-04-01$313.99$227.01RVU17B
2017-01-01$313.99$227.01RVU17A
2016-10-01$315.60$227.13RVU16D
2016-07-01$315.60$227.13RVU16C
2016-04-01$315.60$227.13RVU16B
2016-01-01$315.60$227.13RVU16A
2015-10-01$317.40$227.95RVU15D
2015-07-01$317.40$227.95RVU15C
2015-04-01$315.82$226.82RVU15B
2015-01-01$315.82$226.82RVU15A
2014-10-01$310.59$222.36RVU14D
2014-07-01$310.59$222.36RVU14C
2014-04-01$310.59$222.36RVU14B
2014-01-01$310.59$222.36RVU14A
2013-10-01$312.16$220.53RVU13D
2013-07-01$312.16$220.53RVU13C
2013-04-01$312.16$220.53RVU13B
2013-01-01$312.16$220.53RVU13AR

Price 40801 for an earlier date of service

Where the Utah rate applies

Utah is a Medicare payment area, not a city. Our Census mapping connects it to 334 cities and communities in Utah. Some span more than one payment area; confirm with the service ZIP.

  • Alpine
  • Alta
  • Altamont
  • Alton
  • Amalga
  • American Fork
  • Aneth
  • Annabella

Browse all communities in Utah

40801 billing questions

How is 40801 different from 40800?

40801 is for complicated drainage of a collection in the mouth vestibule; 40800 represents the simpler drainage service. The operative documentation should support the level reported.

Can a biopsy or excision be reported instead?

Use a biopsy code when tissue is sampled for diagnosis, and an excision code when the lesion is removed. Drainage describes incision and evacuation of a collection.

Are related postoperative visits separately billable?

Related postoperative visits during the 10-day global period are included in this service.

Can modifier 50 be used for collections on both sides?

No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.

How does Medicare handle another procedure in the same session?

The highest-valued procedure is paid in full, and other procedures performed in the same session are subject to the standard multiple-procedure reduction.

Can an assistant or co-surgeon be reported?

Medicare does not pay an assistant at surgery for this service. Co-surgeons and team surgery are not permitted.

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

Show the CMS file lines behind this rate
RVUs for 40801PPRRVU2026_Oct_nonQPP.csv, line 4,858 (RVU26D)
Geographic factors for UtahGPCI2026.csv, line 104 (RVU26D)

Open CMS sourceHow we calculate rates

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