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CPT code 40804: Foreign body removal, simple intraoral removal2026 Medicare rate & RVUs in Suburban Chicago, IL

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 Suburban Chicago, IL, Medicare pays $218.61 for 40804 in the office and $122.57 when it’s performed in a hospital or facility.

$218.61Office (non-facility)
$122.57Hospital or facility
+4.6%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 Suburban Chicago, IL
  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 Suburban Chicago, IL 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. Suburban Chicago, IL pays $218.61. The RVUs are the same everywhere; the geographic indexes change the dollars.

40804 in Suburban Chicago, IL vs other payment areas
  1. Suburban Chicago, IL · this page$218.61
  2. Chicago, IL · Illinois$218.41−$0.20
  3. East St. Louis, IL · Illinois$202.70−$15.91
  4. Rest of Illinois · Illinois$198.71−$19.90
  5. Los Angeles, CA · California$238.04+$19.43
  6. Washington, DC area · District of Columbia$240.64+$22.03
  7. Miami, FL · Florida$225.37+$6.76

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

Every other payment area

40804 in every other Medicare payment locality
Payment localityOfficeFacility
Manhattan, NYNew York$241.50$132.82
AlaskaAlaska$237.87$138.27
AlabamaAlabama$186.29$104.46
ArkansasArkansas$183.41$103.07
ArizonaArizona$203.21$112.58
Bakersfield, CACalifornia$222.81$120.30
Chico, CACalifornia$222.26$119.76
El Centro, CACalifornia$222.29$119.79

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 Suburban Chicago, IL 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

50

Locality
Suburban Chicago, IL
Physician work
1.007
Practice expense
1.027
Malpractice
1.772
Office calculation for 40804 in Suburban Chicago, IL
ComponentRVULocality factorAdjusted
Physician work1.27× 1.0071.2789
Practice expense4.80× 1.0274.9296
Malpractice0.19× 1.7720.3367
Total RVUs6.5452
Conversion factor× 33.4009

Office rate, Suburban Chicago, IL$218.61

Office: (1.27 × 1.007 + 4.8 × 1.027 + 0.19 × 1.772) × $33.4009 = $218.61

Facility: (1.27 × 1.007 + 2 × 1.027 + 0.19 × 1.772) × $33.4009 = $122.57

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, Suburban Chicago, IL
Same family
40805Foreign body removal, complicated vestibular removalComplicated intraoral foreign body removal; distinguish by the complexity documented.$305.11
Often billed with
40800Oral drainage, simple vestibular drainageMay accompany removal when a separate oral lesion is also drained and documented.$218.60
40830Mouth laceration repair, simple vestibular repairMay accompany removal when a resulting mouth laceration also requires distinct repair.$242.60

How 40804 has changed in Suburban Chicago, IL

40804 · Office / nonfacility

$218.61

Effective 2026-10-01

The base rate is $16.86 higher than on 2025-10-01, moving from $201.75 to $218.61 (8.4%).

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

    $201.75changed to$218.61

    • 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
    • Practice expense GPCI 1.048 changed to 1.027
    • Malpractice GPCI 1.556 changed to 1.772

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $199.61changed to$201.75

    • 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

    $196.35changed to$199.61

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $201.90changed to$196.35

    • 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
    • Practice expense GPCI 1.055 changed to 1.048
    • Malpractice GPCI 1.530 changed to 1.556

  5. January 1, 2023

    RVU23A

    $205.80changed to$201.90

    • 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 1.006 changed to 1.007
    • Practice expense GPCI 1.062 changed to 1.055
    • Malpractice GPCI 1.504 changed to 1.530

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $214.33changed to$205.80

    • 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

    $215.57changed to$214.33

    • 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 1.008 changed to 1.006
    • Practice expense GPCI 1.057 changed to 1.062
    • Malpractice GPCI 1.535 changed to 1.504

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $209.41changed to$215.57

    • 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 1.009 changed to 1.008
    • Practice expense GPCI 1.053 changed to 1.057
    • Malpractice GPCI 1.565 changed to 1.535

    Held through RVU20B, RVU20C, RVU20D.

  9. July 1, 2019

    RVU19C

    $208.84changed to$209.41

    • Malpractice RVU 0.18 changed to 0.19

    Held through RVU19D.

  10. January 1, 2019

    RVU19A

    $201.22changed to$208.84

    • 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

    $202.52changed to$201.22

    • 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 1.011 changed to 1.009
    • Practice expense GPCI 1.055 changed to 1.053
    • Malpractice GPCI 1.601 changed to 1.565

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $211.88changed to$202.52

    • 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 1.012 changed to 1.011
    • Practice expense GPCI 1.057 changed to 1.055
    • Malpractice GPCI 1.636 changed to 1.601

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $236.20changed to$211.88

    • 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

    $235.02changed to$236.20

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $242.99changed to$235.02

    • 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 1.019 changed to 1.012
    • Practice expense GPCI 1.065 changed to 1.057
    • Malpractice GPCI 1.671 changed to 1.636

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    $247.93changed to$242.99

    • 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 1.025 changed to 1.019
    • Practice expense GPCI 1.072 changed to 1.065
    • Malpractice GPCI 1.706 changed to 1.671

    Held through RVU14B, RVU14C, RVU14D.

  17. October 1, 2013

    RVU13D

    No ratechanged to$247.93

  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$218.61$122.57RVU26D
2026-07-01$218.61$122.57RVU26C
2026-04-01$218.61$122.57RVU26B
2026-01-01$218.61$122.57RVU26A
2025-10-01$201.75$122.77RVU25D
2025-07-01$201.75$122.77RVU25C
2025-04-01$201.75$122.77RVU25B
2025-01-01$201.75$122.77RVU25A
2024-10-01$199.61$120.77RVU24D
2024-07-01$199.61$120.77RVU24C
2024-04-01$199.61$120.77RVU24B
2024-03-09$199.61$120.77RVU24AR
2024-01-01$196.35$118.80RVU24A
2023-10-01$201.90$121.46RVU23D
2023-07-01$201.90$121.46RVU23C
2023-04-01$201.90$121.46RVU23B
2023-01-01$201.90$121.46RVU23A
2022-10-01$205.80$120.90RVU22D
2022-07-01$205.80$120.90RVU22C
2022-04-01$205.80$120.90RVU22B
2022-01-01$205.80$120.90RVU22A
2021-10-01$214.33$123.54RVU21D
2021-07-01$214.33$123.54RVU21C
2021-04-01$214.33$123.54RVU21B
2021-01-01$214.33$123.54RVU21A
2020-10-01$215.57$130.12RVU20D
2020-07-01$215.57$130.12RVU20C
2020-04-01$215.57$130.12RVU20B
2020-01-01$215.57$130.12RVU20A
2019-10-01$209.41$129.33RVU19D
2019-07-01$209.41$129.33RVU19C
2019-04-01$208.84$128.77RVU19B
2019-01-01$208.84$128.77RVU19A
2018-10-01$201.22$126.54RVU18D
2018-07-01$201.22$126.54RVU18C
2018-04-01$201.22$126.54RVU18B
2018-01-01$201.22$126.54RVU18AR1
2017-10-01$202.52$126.80RVU17D
2017-07-01$202.52$126.80RVU17C
2017-04-01$202.52$126.80RVU17B
2017-01-01$202.52$126.80RVU17A
2016-10-01$211.88$131.65RVU16D
2016-07-01$211.88$131.65RVU16C
2016-04-01$211.88$131.65RVU16B
2016-01-01$211.88$131.65RVU16A
2015-10-01$236.20$147.70RVU15D
2015-07-01$236.20$147.70RVU15C
2015-04-01$235.02$146.97RVU15B
2015-01-01$235.02$146.97RVU15A
2014-10-01$242.99$149.14RVU14D
2014-07-01$242.99$149.14RVU14C
2014-04-01$242.99$149.14RVU14B
2014-01-01$242.99$149.14RVU14A
2013-10-01$247.93$151.28RVU13D
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 Suburban Chicago, IL rate applies

Suburban Chicago, IL is a Medicare payment area, not a city. Our Census mapping connects it to 178 cities and communities in Illinois. Some span more than one payment area; confirm with the service ZIP.

Browse all communities in Illinois

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 Suburban Chicago, ILGPCI2026.csv, line 50 (RVU26D)

Open CMS sourceHow we calculate rates

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