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CPT code 41018: Abscess drainage, parapharyngeal space, external approach2026 Medicare rate & RVUs in Puerto Rico

Reports surgical drainage of an abscess in the parapharyngeal space through an external approach, typically for a deep neck infection requiring operative access.

CMS RVU26DEffective Oct 1, 2026One payment locality165 Medicare services in 2024

In Puerto Rico, Medicare pays $551.99 for 41018 in the office and $376.39 when it’s performed in a hospital or facility.

$551.99Office (non-facility)
$376.39Hospital or facility
+0.6%vs the national office rate ($548.44)

Check a contract rate as a % of Medicare · 41018 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 41018 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 41018 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 41018 covers

This service involves surgically opening and draining an infected collection in the parapharyngeal space through an external, typically transcervical, approach. It is generally performed by an otolaryngologist or oral and maxillofacial surgeon in an operating room when the infection’s location or extent calls for operative access to this deep space. The operative work addresses the parapharyngeal collection, rather than a more superficial mouth or neck abscess.

Report the code when the documented site is the parapharyngeal space and the surgeon performs external drainage. The operative note should identify the involved space, approach, and drainage performed; a general diagnosis of a neck abscess alone does not establish the specific service. This major surgery has a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. When other procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate. 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 Puerto Rico compares for 41018

Across 109 of 109 payment localities, the office rate for 41018 runs from $486.93 in Arkansas to $712.93 in San Benito County, CA. Puerto Rico pays $551.99. The RVUs are the same everywhere; the geographic indexes change the dollars.

41018 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$551.99
  2. Los Angeles, CA · California$612.36+$60.37
  3. Washington, DC area · District of Columbia$623.44+$71.45
  4. Miami, FL · Florida$599.25+$47.26
  5. Chicago, IL · Illinois$582.12+$30.13
  6. Manhattan, NY · New York$630.68+$78.69
  7. Alaska · Alaska$645.86+$93.87

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

Every other payment area

41018 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$493.81$341.84
ArkansasArkansas$486.93$337.73
ArizonaArizona$534.03$365.73
Bakersfield, CACalifornia$576.45$386.10
Chico, CACalifornia$574.38$384.02
El Centro, CACalifornia$574.50$384.14
Fresno, CACalifornia$574.38$384.02
Hanford, CACalifornia$574.38$384.02

41018 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.

$486.93

$645.86

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

View every state and territory as a table
41018 office rate range by state
State / territoryOffice rate rangeLocalities
AK$645.861
AL$493.811
AR$486.931
AZ$534.031
CA$574.38–$712.9329
CO$567.991
CT$584.141
DC$623.441
DE$542.641
FL$544.76–$599.253
GA$514.69–$559.392
GU$587.061
HI$587.061
IA$503.991
ID$507.571
IL$530.93–$582.124
IN$510.361
KS$502.631
KY$507.051
LA$506.65–$530.742
MA$565.15–$621.622
MD$552.45–$623.443
ME$511.10–$536.502
MI$520.64–$552.302
MN$542.031
MO$498.88–$531.463
MS$492.951
MT$548.401
NC$516.121
ND$534.361
NE$506.381
NH$560.021
NJ$590.18–$617.522
NM$523.771
NV$544.841
NY$523.66–$646.695
OH$517.771
OK$505.201
OR$539.98–$584.472
PA$518.05–$570.622
PR$551.991
RI$560.821
SC$517.931
SD$532.701
TN$505.181
TX$514.83–$566.658
UT$524.741
VA$535.44–$623.442
VI$551.991
VT$533.181
WA$563.79–$633.122
WI$517.131
WV$512.201
WY$542.281

See 41018 in every payment locality

How the 41018 rate is calculated

Each of 41018’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 · 41018

RVUs × geographic indexes × conversion factor

Office or facility?

Work5.09

5.09 RVUs× 1.000 GPCI

Practice expense10.62

10.62 RVUs× 1.000 GPCI

Malpractice0.71

0.71 RVUs× 1.000 GPCI

Adjusted RVUs

16.4200

Conversion factor

$33.4009

Medicare rate

$548.44

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

The exact Puerto Rico inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

4,893

Code
41018
Physician work
5.09
Practice expense
10.62
Malpractice
0.71

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 41018 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work5.09× 1.0005.0900
Practice expense10.62× 1.01110.7368
Malpractice0.71× 0.9850.6993
Total RVUs16.5262
Conversion factor× 33.4009

Office rate, Puerto Rico$551.99

Office: (5.09 × 1 + 10.62 × 1.011 + 0.71 × 0.985) × $33.4009 = $551.99

Facility: (5.09 × 1 + 5.42 × 1.011 + 0.71 × 0.985) × $33.4009 = $376.39

Open 41018 in the RVU calculator

Payment rules and modifiers for 41018

41018 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 41018

Abscess drainage, parapharyngeal space, external approach

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 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)0.09/0.81/0.10Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 41018

Abscess drainage, parapharyngeal space, external approach

90-day global period ends

Dec 30, 2026

Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).

Visit on Oct 31, 2026

Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

41018 without 51 · national office

$548.44

Abscess drainage, parapharyngeal space, external approach

41018-51 · Second procedure: 50%

$274.22

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 41018

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

Codes related to 41018
CodeHow it relatesOffice range, Puerto Rico
Same family
41015Mouth lesion drainage, extraoral floor-of-mouth approachDrainage of a floor-of-mouth abscess through a submental approach.$413.16
41016Abscess drainage, intraoral deep-space approachDrainage of a floor-of-mouth abscess through a submandibular approach.$486.98
41017Lesion drainage, floor of mouth, intraoralDrainage of an abscess in the masticator space.$482.26

How 41018 has changed in Puerto Rico

41018 · Office / nonfacility

$551.99

Effective 2026-10-01

The base rate is $38.03 higher than on 2025-10-01, moving from $513.96 to $551.99 (7.4%).

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

    $513.96changed to$551.99

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 5.22 changed to 5.09
    • Practice expense RVU 10.01 changed to 10.62
    • Malpractice RVU 0.60 changed to 0.71
    • Practice expense GPCI 1.007 changed to 1.011
    • Malpractice GPCI 0.982 changed to 0.985

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $526.24changed to$513.96

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 9.94 changed to 10.01
    • Malpractice RVU 0.59 changed to 0.60

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $517.65changed to$526.24

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $537.49changed to$517.65

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 10.01 changed to 9.94
    • Malpractice RVU 0.56 changed to 0.59
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $535.08changed to$537.49

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984

  6. January 1, 2023

    RVU23A

    $541.26changed to$535.08

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 9.79 changed to 10.01
    • Practice expense GPCI 1.008 changed to 1.000
    • Malpractice GPCI 0.986 changed to 1.000

    Held through RVU23B, RVU23C.

  7. January 1, 2022

    RVU22A

    $541.91changed to$541.26

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 9.72 changed to 9.79
    • Malpractice RVU 0.52 changed to 0.56

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $528.51changed to$541.91

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 8.84 changed to 9.72
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $532.73changed to$528.51

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 8.66 changed to 8.84
    • Malpractice RVU 0.85 changed to 0.52
    • Practice expense GPCI 1.007 changed to 1.008
    • Malpractice GPCI 0.990 changed to 0.988

    Held through RVU20B, RVU20C, RVU20D.

  10. January 1, 2019

    RVU19A

    $529.61changed to$532.73

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 8.58 changed to 8.66
    • Malpractice RVU 0.86 changed to 0.85

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $472.66changed to$529.61

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 8.65 changed to 8.58
    • Malpractice RVU 0.85 changed to 0.86
    • Practice expense GPCI 0.856 changed to 1.007
    • Malpractice GPCI 0.642 changed to 0.990

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $416.14changed to$472.66

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 8.72 changed to 8.65
    • Malpractice RVU 0.87 changed to 0.85
    • Practice expense GPCI 0.705 changed to 0.856
    • Malpractice GPCI 0.293 changed to 0.642

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $416.41changed to$416.14

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 8.68 changed to 8.72
    • Malpractice RVU 0.85 changed to 0.87

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $414.34changed to$416.41

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $407.88changed to$414.34

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 8.66 changed to 8.68
    • Malpractice RVU 0.64 changed to 0.85
    • Practice expense GPCI 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    $408.65changed to$407.88

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 9.77 changed to 8.66
    • Malpractice RVU 0.67 changed to 0.64
    • Practice expense GPCI 0.678 changed to 0.692
    • Malpractice GPCI 0.249 changed to 0.271

    Held through RVU14B, RVU14C, RVU14D.

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: $408.65

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$551.99$376.39RVU26D
2026-07-01$551.99$376.39RVU26C
2026-04-01$551.99$376.39RVU26B
2026-01-01$551.99$376.39RVU26A
2025-10-01$513.96$394.42RVU25D
2025-07-01$513.96$394.42RVU25C
2025-04-01$513.96$394.42RVU25B
2025-01-01$513.96$394.42RVU25A
2024-10-01$526.24$400.87RVU24D
2024-07-01$526.24$400.87RVU24C
2024-04-01$526.24$400.87RVU24B
2024-03-09$526.24$400.87RVU24AR
2024-01-01$517.65$394.33RVU24A
2023-10-01$537.49$406.66RVU23D
2023-07-01$535.08$405.29RVU23C
2023-04-01$535.08$405.29RVU23B
2023-01-01$535.08$405.29RVU23A
2022-10-01$541.26$408.00RVU22D
2022-07-01$541.26$408.00RVU22C
2022-04-01$541.26$408.00RVU22B
2022-01-01$541.26$408.00RVU22A
2021-10-01$541.91$410.36RVU21D
2021-07-01$541.91$410.36RVU21C
2021-04-01$541.91$410.36RVU21B
2021-01-01$541.91$410.36RVU21A
2020-10-01$528.51$415.01RVU20D
2020-07-01$528.51$415.01RVU20C
2020-04-01$528.51$415.01RVU20B
2020-01-01$528.51$415.01RVU20A
2019-10-01$532.73$428.94RVU19D
2019-07-01$532.73$428.94RVU19C
2019-04-01$532.73$428.94RVU19B
2019-01-01$532.73$428.94RVU19A
2018-10-01$529.61$433.54RVU18D
2018-07-01$529.61$433.54RVU18C
2018-04-01$529.61$433.54RVU18B
2018-01-01$529.61$433.54RVU18AR1
2017-10-01$472.66$391.86RVU17D
2017-07-01$472.66$391.86RVU17C
2017-04-01$472.66$391.86RVU17B
2017-01-01$472.66$391.86RVU17A
2016-10-01$416.14$349.50RVU16D
2016-07-01$416.14$349.50RVU16C
2016-04-01$416.14$349.50RVU16B
2016-01-01$416.14$349.50RVU16A
2015-10-01$416.41$349.03RVU15D
2015-07-01$416.41$349.03RVU15C
2015-04-01$414.34$347.29RVU15B
2015-01-01$414.34$347.29RVU15A
2014-10-01$407.88$343.18RVU14D
2014-07-01$407.88$343.18RVU14C
2014-04-01$407.88$343.18RVU14B
2014-01-01$407.88$343.18RVU14A
2013-10-01$408.65$336.91RVU13D
2013-07-01$408.65$336.91RVU13C
2013-04-01$408.65$336.91RVU13B
2013-01-01$408.65$336.91RVU13AR

Price 41018 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

Browse all communities in Puerto Rico

41018 billing questions

How is this distinguished from drainage of a masticator-space abscess?

Use this code for drainage of a parapharyngeal-space collection by an external approach. A collection in the masticator space belongs to the code for that space, even when the infection is also described as a deep neck infection.

Does an intraoral drainage approach qualify?

This code describes external drainage. Confirm the documented operative approach and the infected space rather than selecting the code from the diagnosis alone.

What documentation supports reporting this code?

The operative report should identify the parapharyngeal space, describe the external approach, and document that the collection was surgically drained.

Is the related postoperative care separately reported during the global period?

The 90-day global period includes the day-before preoperative visit and related postoperative care. The code’s global period does not make unrelated services part of that package.

Can an assistant surgeon or co-surgeon be reported?

Assistant-at-surgery payment is allowed only when medical necessity is documented. Co-surgeons and team surgery are not permitted for this code.

How is payment adjusted when another procedure is performed in the same session?

The highest-valued procedure is paid in full, and the other procedure or procedures are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate for this code.

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 41018PPRRVU2026_Oct_nonQPP.csv, line 4,893 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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