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CPT code 40804: Foreign body removal, simple intraoral removal2026 Medicare rate & RVUs in Santa Clara County, CA

Reports straightforward removal of a foreign object from inside the mouth, such as an object lodged in oral soft tissue and extracted without extensive dissection.

CMS RVU26DEffective Oct 1, 2026One payment locality77 Medicare services in 2024

In Santa Clara County, CA, Medicare pays $280.79 for 40804 in the office and $145.93 when it’s performed in a hospital or facility.

$280.79Office (non-facility)
$145.93Hospital or facility
+34.3%vs the national office rate ($209.09)

Check a contract rate as a % of Medicare · 40804 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 40804 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Santa Clara County, CA
  2. What 40804 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 40804 covers

This service covers a straightforward extraction of a foreign object from inside the mouth. A physician, dentist, or other qualified practitioner may perform it in an office, emergency department, or operating setting when an object is lodged in oral tissue and can be removed without extensive dissection. Examples may include a small fragment embedded in the cheek or gum tissue. The key distinction from 40805 is the complexity of the removal, not simply the object’s identity.

Report 40804 when the documented work supports a simple intraoral extraction; describe the object’s location and the steps used to remove it. Related postoperative visits during the 10-day global period are included. If other procedures occur in the same session, the highest-valued procedure is paid in full and the others are subject to the standard 50% multiple-procedure reduction. Do not use modifier 50 for bilateral removal. Assistant-at-surgery payment requires documented medical necessity; 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 Santa Clara County, CA compares for 40804

Across 109 of 109 payment localities, the office rate for 40804 runs from $183.41 in Arkansas to $281.67 in San Benito County, CA. Santa Clara County, CA pays $280.79. The RVUs are the same everywhere; the geographic indexes change the dollars.

40804 in Santa Clara County, CA vs other payment areas
  1. Santa Clara County, CA · this page$280.79
  2. Bakersfield, CA · California$222.81−$57.98
  3. Chico, CA · California$222.26−$58.53
  4. El Centro, CA · California$222.29−$58.50
  5. Fresno, CA · California$222.26−$58.53
  6. Hanford, CA · California$222.26−$58.53
  7. Los Angeles, CA · California$238.04−$42.75

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

Every other payment area

40804 in every other Medicare payment locality
Payment localityOfficeFacility
Madera, CACalifornia$222.26$119.76
Merced, CACalifornia$222.26$119.76
Modesto, CACalifornia$222.26$119.76
Napa, CACalifornia$259.62$136.36
Oxnard, CACalifornia$237.06$126.52
Redding, CACalifornia$222.26$119.76
Rest of CaliforniaCalifornia$222.26$119.76
Riverside, CACalifornia$224.31$121.81

40804 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.

$183.41

$251.97

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

View every state and territory as a table
40804 office rate range by state
State / territoryOffice rate rangeLocalities
AK$237.871
AL$186.291
AR$183.411
AZ$203.211
CA$222.26–$281.6729
CO$218.471
CT$223.621
DC$240.641
DE$206.741
FL$205.23–$225.373
GA$192.99–$213.062
GU$228.381
HI$228.381
IA$191.641
ID$192.921
IL$198.71–$218.614
IN$194.121
KS$190.551
KY$190.751
LA$190.39–$200.492
MA$216.98–$241.232
MD$210.92–$240.643
ME$193.86–$205.302
MI$195.96–$207.832
MN$209.271
MO$186.80–$201.413
MS$185.151
MT$209.081
NC$196.061
ND$205.321
NE$192.801
NH$214.871
NJ$226.15–$237.852
NM$197.061
NV$208.191
NY$199.19–$247.545
OH$195.191
OK$190.521
OR$206.56–$225.942
PA$195.59–$217.652
PR$210.761
RI$214.501
SC$195.951
SD$204.881
TN$191.561
TX$194.21–$217.758
UT$198.821
VA$204.50–$240.642
VI$210.761
VT$204.351
WA$216.62–$246.442
WI$197.961
WV$190.821
WY$207.441

See 40804 in every payment locality

How the 40804 rate is calculated

Each of 40804’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 · 40804

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.27

1.27 RVUs× 1.000 GPCI

Practice expense4.80

4.80 RVUs× 1.000 GPCI

Malpractice0.19

0.19 RVUs× 1.000 GPCI

Adjusted RVUs

6.2600

Conversion factor

$33.4009

Medicare rate

$209.09

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

The exact Santa Clara County, CA inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

4,859

Code
40804
Physician work
1.27
Practice expense
4.80
Malpractice
0.19

GPCI2026.csv

28

Locality
Santa Clara County, CA
Physician work
1.110
Practice expense
1.442
Malpractice
0.397
Office calculation for 40804 in Santa Clara County, CA
ComponentRVULocality factorAdjusted
Physician work1.27× 1.1101.4097
Practice expense4.80× 1.4426.9216
Malpractice0.19× 0.3970.0754
Total RVUs8.4067
Conversion factor× 33.4009

Office rate, Santa Clara County, CA$280.79

Office: (1.27 × 1.11 + 4.8 × 1.442 + 0.19 × 0.397) × $33.4009 = $280.79

Facility: (1.27 × 1.11 + 2 × 1.442 + 0.19 × 0.397) × $33.4009 = $145.93

Open 40804 in the RVU calculator

Payment rules and modifiers for 40804

40804 has a 10-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 40804

Foreign body removal, simple intraoral removal

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)0Not paid without supporting documentation.
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 · 40804

Foreign body removal, simple intraoral removal

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

40804 without 51 · national office

$209.09

Foreign body removal, simple intraoral removal

40804-51 · Second procedure: 50%

$104.55

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 40804

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

Codes related to 40804
CodeHow it relatesOffice range, Santa Clara County, CA
Same family
40805Foreign body removal, complicated vestibular removalComplicated intraoral foreign body removal; distinguish by the complexity documented.$379.84
Often billed with
40800Oral drainage, simple vestibular drainageMay accompany removal when a separate oral lesion is also drained and documented.$283.58
40830Mouth laceration repair, simple vestibular repairMay accompany removal when a resulting mouth laceration also requires distinct repair.$306.60

How 40804 has changed in Santa Clara County, CA

40804 · Office / nonfacility

$280.79

Effective 2026-10-01

The base rate is $25.67 higher than on 2025-10-01, moving from $255.12 to $280.79 (10.1%).

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

    $255.12changed to$280.79

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.30 changed to 1.27
    • Practice expense RVU 4.45 changed to 4.80
    • Malpractice RVU 0.17 changed to 0.19
    • Work GPCI 1.100 changed to 1.110
    • Practice expense GPCI 1.435 changed to 1.442
    • Malpractice GPCI 0.420 changed to 0.397

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $252.71changed to$255.12

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 4.25 changed to 4.45
    • Malpractice RVU 0.15 changed to 0.17

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $248.59changed to$252.71

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $249.40changed to$248.59

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 4.16 changed to 4.25
    • Malpractice RVU 0.17 changed to 0.15
    • Work GPCI 1.098 changed to 1.100
    • Practice expense GPCI 1.409 changed to 1.435
    • Malpractice GPCI 0.417 changed to 0.420

  5. January 1, 2023

    RVU23A

    $250.89changed to$249.40

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 4.17 changed to 4.16
    • Malpractice RVU 0.14 changed to 0.17
    • Work GPCI 1.096 changed to 1.098
    • Practice expense GPCI 1.383 changed to 1.409
    • Malpractice GPCI 0.414 changed to 0.417

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $261.32changed to$250.89

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 4.34 changed to 4.17
    • Malpractice RVU 0.15 changed to 0.14

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $258.73changed to$261.32

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 4.15 changed to 4.34
    • Malpractice RVU 0.18 changed to 0.15
    • Work GPCI 1.089 changed to 1.096
    • Practice expense GPCI 1.369 changed to 1.383
    • Malpractice GPCI 0.401 changed to 0.414

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $248.10changed to$258.73

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 3.99 changed to 4.15
    • Malpractice RVU 0.19 changed to 0.18
    • Work GPCI 1.083 changed to 1.089
    • Practice expense GPCI 1.354 changed to 1.369
    • Malpractice GPCI 0.388 changed to 0.401

    Held through RVU20B, RVU20C, RVU20D.

  9. July 1, 2019

    RVU19C

    $247.96changed to$248.10

    • Malpractice RVU 0.18 changed to 0.19

    Held through RVU19D.

  10. January 1, 2019

    RVU19A

    $237.59changed to$247.96

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 3.78 changed to 3.99
    • Malpractice RVU 0.19 changed to 0.18

    Held through RVU19B.

  11. January 1, 2018

    RVU18AR1

    $238.96changed to$237.59

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 3.83 changed to 3.78
    • Malpractice RVU 0.18 changed to 0.19
    • Work GPCI 1.086 changed to 1.083
    • Practice expense GPCI 1.351 changed to 1.354
    • Malpractice GPCI 0.402 changed to 0.388

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $249.28changed to$238.96

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 4.06 changed to 3.83
    • Malpractice RVU 0.19 changed to 0.18
    • Work GPCI 1.088 changed to 1.086
    • Practice expense GPCI 1.347 changed to 1.351
    • Malpractice GPCI 0.416 changed to 0.402

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $280.19changed to$249.28

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 4.68 changed to 4.06

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $278.79changed to$280.19

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $288.02changed to$278.79

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 4.89 changed to 4.68
    • Malpractice RVU 0.15 changed to 0.19
    • Work GPCI 1.083 changed to 1.088
    • Practice expense GPCI 1.342 changed to 1.347
    • Malpractice GPCI 0.466 changed to 0.416

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    $291.53changed to$288.02

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 5.30 changed to 4.89
    • Malpractice RVU 0.16 changed to 0.15
    • Work GPCI 1.077 changed to 1.083
    • Practice expense GPCI 1.337 changed to 1.342
    • Malpractice GPCI 0.516 changed to 0.466

    Held through RVU14B, RVU14C, RVU14D.

  17. October 1, 2013

    RVU13D

    No ratechanged to$291.53

  18. January 1, 2013

    RVU13AR

    Earliest loaded release: No rate

    Held through RVU13B, RVU13C.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$280.79$145.93RVU26D
2026-07-01$280.79$145.93RVU26C
2026-04-01$280.79$145.93RVU26B
2026-01-01$280.79$145.93RVU26A
2025-10-01$255.12$146.97RVU25D
2025-07-01$255.12$146.97RVU25C
2025-04-01$255.12$146.97RVU25B
2025-01-01$255.12$146.97RVU25A
2024-10-01$252.71$144.76RVU24D
2024-07-01$252.71$144.76RVU24C
2024-04-01$252.71$144.76RVU24B
2024-03-09$252.71$144.76RVU24AR
2024-01-01$248.59$142.39RVU24A
2023-10-01$249.40$141.97RVU23D
2023-07-01$249.40$141.97RVU23C
2023-04-01$249.40$141.97RVU23B
2023-01-01$249.40$141.97RVU23A
2022-10-01$250.89$140.33RVU22D
2022-07-01$250.89$140.33RVU22C
2022-04-01$250.89$140.33RVU22B
2022-01-01$250.89$140.33RVU22A
2021-10-01$261.32$143.09RVU21D
2021-07-01$261.32$143.09RVU21C
2021-04-01$261.32$143.09RVU21B
2021-01-01$261.32$143.09RVU21A
2020-10-01$258.73$148.06RVU20D
2020-07-01$258.73$148.06RVU20C
2020-04-01$258.73$148.06RVU20B
2020-01-01$258.73$148.06RVU20A
2019-10-01$248.10$145.13RVU19D
2019-07-01$248.10$145.13RVU19C
2019-04-01$247.96$144.99RVU19B
2019-01-01$247.96$144.99RVU19A
2018-10-01$237.59$141.56RVU18D
2018-07-01$237.59$141.56RVU18C
2018-04-01$237.59$141.56RVU18B
2018-01-01$237.59$141.56RVU18AR1
2017-10-01$238.96$141.99RVU17D
2017-07-01$238.96$141.99RVU17C
2017-04-01$238.96$141.99RVU17B
2017-01-01$238.96$141.99RVU17A
2016-10-01$249.28$147.03RVU16D
2016-07-01$249.28$147.03RVU16C
2016-04-01$249.28$147.03RVU16B
2016-01-01$249.28$147.03RVU16A
2015-10-01$280.19$167.41RVU15D
2015-07-01$280.19$167.41RVU15C
2015-04-01$278.79$166.58RVU15B
2015-01-01$278.79$166.58RVU15A
2014-10-01$288.02$169.76RVU14D
2014-07-01$288.02$169.76RVU14C
2014-04-01$288.02$169.76RVU14B
2014-01-01$288.02$169.76RVU14A
2013-10-01$291.53$170.99RVU13D
2013-07-01Rate data unavailableRate data unavailableRVU13C
2013-04-01Rate data unavailableRate data unavailableRVU13B
2013-01-01Rate data unavailableRate data unavailableRVU13AR

Price 40804 for an earlier date of service

Where the Santa Clara County, CA rate applies

Santa Clara County, CA is a Medicare payment area, not a city. Our Census mapping connects it to 24 cities and communities in California. Some span more than one payment area; confirm with the service ZIP.

  • San Jose
  • Santa Clara
  • Sunnyvale
  • Alum Rock
  • Burbank
  • Cambrian Park
  • Campbell
  • Cupertino

Browse all communities in California

40804 billing questions

How do I choose 40804 rather than 40805?

Use 40804 for a simple intraoral extraction. Use 40805 when the documented removal is complicated; the distinction is the complexity of the extraction.

Can removal of a foreign object be reported with drainage of an oral lesion?

A separate drainage service may be reported when a lesion is independently drained and the work is documented. Do not report drainage merely for extracting the object.

Are postoperative visits billed separately?

Related postoperative visits during the 10-day global period are included in 40804.

Should modifier 50 be used for objects on both sides of the mouth?

No. CMS bilateral adjustment does not apply to this service, and modifier 50 is inappropriate.

What supports reporting 40804?

Document the foreign object’s intraoral location and the removal performed, including enough detail to support a simple rather than complicated extraction.

Can an assistant or another surgeon be paid for the procedure?

Assistant-at-surgery payment requires documentation of medical necessity. 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 40804PPRRVU2026_Oct_nonQPP.csv, line 4,859 (RVU26D)
Geographic factors for Santa Clara County, CAGPCI2026.csv, line 28 (RVU26D)

Open CMS sourceHow we calculate rates

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