CPT code 40805: Foreign body removal, complicated vestibular removal2026 Medicare rate & RVUs in Maryland
Removal of an embedded foreign body from the oral vestibule when the retrieval is complicated, rather than a simple extraction.
Medicare pays $293.97–$331.58 for 40805 in the office in Maryland, from Rest of Maryland to Washington, DC area. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 40805 covers
This service removes an embedded object from the oral vestibule, the space between the lips or cheeks and the teeth or gums. The clinician exposes and retrieves the object using the additional work needed for a complicated removal. Oral and maxillofacial surgeons, dentists, and otolaryngologists may perform it in an office or another appropriate setting when an object is lodged in this tissue.
Choose this code rather than 40804 when the removal is complicated; document the object’s location and the work required to expose and retrieve it. A loose object that can be removed simply does not support the complicated level. The procedure has a 10-day global period, which includes related postoperative visits during that period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate for this service. Assistant-at-surgery payment requires documentation of 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.
Where 40805 pays more and less in Maryland
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$293.97 to $331.58
| Payment locality | Office | Facility |
|---|---|---|
| Baltimore area, MD | $309.34 | $193.94 |
| Rest of Maryland | $293.97 | $185.12 |
| Washington, DC area | $331.58 | $204.88 |
How the 40805 rate is calculated
Each of 40805’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 · 40805
RVUs × geographic indexes × conversion factor
Work2.72
2.72 RVUs× 1.000 GPCI
Practice expense5.71
5.71 RVUs× 1.000 GPCI
Malpractice0.30
0.30 RVUs× 1.000 GPCI
Adjusted RVUs
8.7300
Conversion factor
$33.4009
Medicare rate
$291.59
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 40805
40805 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 40805
Foreign body removal, complicated vestibular removal
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 40805
Foreign body removal, complicated vestibular 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.
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
40805 without 51 · national office
$291.59
Foreign body removal, complicated vestibular removal
40805-51 · Second procedure: 50%
$145.80
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%).
40805 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 40804Foreign body removalSimple intraoral removal
- Use 40804 for simple removal of an embedded foreign body from the oral vestibule. Use 40805 when the retrieval is complicated, with documentation of the additional work.
- 40808Mouth biopsyOral vestibule
- 40808 is for sampling a lesion in the mouth for biopsy. It is not the code for retrieving an embedded foreign object.
- 40810Mouth lesion excisionWithout repair
- 40810 describes excision of a mouth lesion. Choose 40805 when the target is an embedded foreign body, not tissue being excised as a lesion.
40805 billing questions
How does this differ from 40804?
40805 is for a complicated removal of an embedded foreign body in the oral vestibule; 40804 represents the simple removal. Document the factors that made retrieval complicated.
Does this code cover removal of a loose object?
No. This code describes a complicated removal of an embedded object. A loose object removed simply does not support this level.
Are related postoperative visits separately reported?
Related postoperative visits during the 10-day global period are included in the procedure.
Should modifier 50 be appended for objects on both sides?
No. The CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.
Can an assistant surgeon be reported?
Assistant-at-surgery payment is available only when medical necessity is documented. Co-surgeons and team surgery are not permitted.
What documentation supports the complicated level?
Record the foreign body’s specific oral vestibule location and the additional work needed to expose and retrieve it, distinguishing the service from simple removal.
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
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