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CPT code 40804: Foreign body removal, simple intraoral removal2026 Medicare rate & RVUs in South Carolina

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 South Carolina, Medicare pays $195.95 for 40804 in the office and $109.54 when it’s performed in a hospital or facility.

$195.95Office (non-facility)
$109.54Hospital or facility
−6.3%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 South Carolina
  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 South Carolina 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. South Carolina pays $195.95. The RVUs are the same everywhere; the geographic indexes change the dollars.

40804 in South Carolina vs other payment areas
  1. South Carolina · this page$195.95
  2. Los Angeles, CA · California$238.04+$42.09
  3. Washington, DC area · District of Columbia$240.64+$44.69
  4. Miami, FL · Florida$225.37+$29.42
  5. Chicago, IL · Illinois$218.41+$22.46
  6. Manhattan, NY · New York$241.50+$45.55
  7. Alaska · Alaska$237.87+$41.92

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

Every other payment area

40804 in every other Medicare payment locality
Payment localityOfficeFacility
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
Fresno, CACalifornia$222.26$119.76
Hanford, CACalifornia$222.26$119.76

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 South Carolina 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

93

Locality
South Carolina
Physician work
1.000
Practice expense
0.924
Malpractice
0.850
Office calculation for 40804 in South Carolina
ComponentRVULocality factorAdjusted
Physician work1.27× 1.0001.2700
Practice expense4.80× 0.9244.4352
Malpractice0.19× 0.8500.1615
Total RVUs5.8667
Conversion factor× 33.4009

Office rate, South Carolina$195.95

Office: (1.27 × 1 + 4.8 × 0.924 + 0.19 × 0.85) × $33.4009 = $195.95

Facility: (1.27 × 1 + 2 × 0.924 + 0.19 × 0.85) × $33.4009 = $109.54

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, South Carolina
Same family
40805Foreign body removal, complicated vestibular removalComplicated intraoral foreign body removal; distinguish by the complexity documented.$275.59
Often billed with
40800Oral drainage, simple vestibular drainageMay accompany removal when a separate oral lesion is also drained and documented.$196.47
40830Mouth laceration repair, simple vestibular repairMay accompany removal when a resulting mouth laceration also requires distinct repair.$218.11

How 40804 has changed in South Carolina

40804 · Office / nonfacility

$195.95

Effective 2026-10-01

The base rate is $17.99 higher than on 2025-10-01, moving from $177.96 to $195.95 (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

    $177.96changed to$195.95

    • 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 0.913 changed to 0.924
    • Malpractice GPCI 0.817 changed to 0.850

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $176.52changed to$177.96

    • 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

    $173.64changed to$176.52

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $176.41changed to$173.64

    • 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 0.908 changed to 0.913
    • Malpractice GPCI 0.756 changed to 0.817

  5. January 1, 2023

    RVU23A

    $178.67changed to$176.41

    • 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
    • Practice expense GPCI 0.903 changed to 0.908
    • Malpractice GPCI 0.695 changed to 0.756

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $185.75changed to$178.67

    • 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

    $186.81changed to$185.75

    • 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
    • Practice expense GPCI 0.907 changed to 0.903
    • Malpractice GPCI 0.624 changed to 0.695

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $181.78changed to$186.81

    • 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
    • Practice expense GPCI 0.912 changed to 0.907
    • Malpractice GPCI 0.553 changed to 0.624

    Held through RVU20B, RVU20C, RVU20D.

  9. July 1, 2019

    RVU19C

    $181.58changed to$181.78

    • Malpractice RVU 0.18 changed to 0.19

    Held through RVU19D.

  10. January 1, 2019

    RVU19A

    $174.69changed to$181.58

    • 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

    $176.11changed to$174.69

    • 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
    • Malpractice GPCI 0.634 changed to 0.553

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $183.98changed to$176.11

    • 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
    • Malpractice GPCI 0.715 changed to 0.634

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $204.97changed to$183.98

    • 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

    $203.95changed to$204.97

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $209.47changed to$203.95

    • 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
    • Practice expense GPCI 0.911 changed to 0.912
    • Malpractice GPCI 0.618 changed to 0.715

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    $210.97changed to$209.47

    • 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
    • Practice expense GPCI 0.909 changed to 0.911
    • Malpractice GPCI 0.520 changed to 0.618

    Held through RVU14B, RVU14C, RVU14D.

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: $210.97

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$195.95$109.54RVU26D
2026-07-01$195.95$109.54RVU26C
2026-04-01$195.95$109.54RVU26B
2026-01-01$195.95$109.54RVU26A
2025-10-01$177.96$109.15RVU25D
2025-07-01$177.96$109.15RVU25C
2025-04-01$177.96$109.15RVU25B
2025-01-01$177.96$109.15RVU25A
2024-10-01$176.52$107.83RVU24D
2024-07-01$176.52$107.83RVU24C
2024-04-01$176.52$107.83RVU24B
2024-03-09$176.52$107.83RVU24AR
2024-01-01$173.64$106.07RVU24A
2023-10-01$176.41$107.18RVU23D
2023-07-01$176.41$107.18RVU23C
2023-04-01$176.41$107.18RVU23B
2023-01-01$176.41$107.18RVU23A
2022-10-01$178.67$106.48RVU22D
2022-07-01$178.67$106.48RVU22C
2022-04-01$178.67$106.48RVU22B
2022-01-01$178.67$106.48RVU22A
2021-10-01$185.75$108.55RVU21D
2021-07-01$185.75$108.55RVU21C
2021-04-01$185.75$108.55RVU21B
2021-01-01$185.75$108.55RVU21A
2020-10-01$186.81$113.49RVU20D
2020-07-01$186.81$113.49RVU20C
2020-04-01$186.81$113.49RVU20B
2020-01-01$186.81$113.49RVU20A
2019-10-01$181.78$112.43RVU19D
2019-07-01$181.78$112.43RVU19C
2019-04-01$181.58$112.23RVU19B
2019-01-01$181.58$112.23RVU19A
2018-10-01$174.69$110.01RVU18D
2018-07-01$174.69$110.01RVU18C
2018-04-01$174.69$110.01RVU18B
2018-01-01$174.69$110.01RVU18AR1
2017-10-01$176.11$110.65RVU17D
2017-07-01$176.11$110.65RVU17C
2017-04-01$176.11$110.65RVU17B
2017-01-01$176.11$110.65RVU17A
2016-10-01$183.98$114.76RVU16D
2016-07-01$183.98$114.76RVU16C
2016-04-01$183.98$114.76RVU16B
2016-01-01$183.98$114.76RVU16A
2015-10-01$204.97$128.61RVU15D
2015-07-01$204.97$128.61RVU15C
2015-04-01$203.95$127.97RVU15B
2015-01-01$203.95$127.97RVU15A
2014-10-01$209.47$129.19RVU14D
2014-07-01$209.47$129.19RVU14C
2014-04-01$209.47$129.19RVU14B
2014-01-01$209.47$129.19RVU14A
2013-10-01$210.97$129.02RVU13D
2013-07-01$210.97$129.02RVU13C
2013-04-01$210.97$129.02RVU13B
2013-01-01$210.97$129.02RVU13AR

Price 40804 for an earlier date of service

Where the South Carolina rate applies

South Carolina is a Medicare payment area, not a city. Our Census mapping connects it to 475 cities and communities in South Carolina. Some span more than one payment area; confirm with the service ZIP.

  • Abbeville
  • Abney Crossroads
  • Adams Run
  • Aiken
  • Alcolu
  • Allendale
  • Anderson
  • Andrews

Browse all communities in South Carolina

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 South CarolinaGPCI2026.csv, line 93 (RVU26D)

Open CMS sourceHow we calculate rates

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