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CMS RVU26D · Effective 2026-10-01

40804 in Modesto

Office / nonfacility

$222.26

Base rate per service

Facility setting

$119.76

Base rate per service

Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.

Oral procedure

About 40804: Simple intraoral foreign body removal

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.

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.

CMS billing rules for 40804

Global period
Minor procedure with a 10-day global period: related postoperative visits for 10 days are included.
Multiple procedures
Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
Bilateral procedures
Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
Assistant at surgery
Assistant at surgery is paid only with documentation of medical necessity.
Co-surgeons
Co-surgeons not permitted.
Team surgery
Team surgery not permitted.

Where the value comes from

  • Work RVU1.27 · 20%
  • Practice expense (office) RVU4.80 · 77%
  • Malpractice RVU0.19 · 3%

77

Medicare services in 2024 · #5087 by national volume

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.

40804 compared with similar codes

Office rates for Modesto, from the same CMS release.

40805

Foreign body removal

Complicated vestibular removal

$306.79

Choose 40804 for a simple extraction and 40805 when the removal is complicated. The operative note should support the level of difficulty.

40800

Oral drainage

Simple vestibular drainage

$223.74

40800 is for draining a mouth lesion, not extracting an object. Report it with 40804 only when distinct drainage is performed.

40808

Mouth biopsy

Oral vestibule

$178.83

40808 is used to biopsy an oral lesion. Removing a foreign object is not a biopsy unless separate tissue sampling is performed.

40830

Mouth laceration repair

Simple vestibular repair

$245.08

40830 repairs a mouth laceration. Use it for distinct wound repair, rather than for the extraction itself.

The same code, a different location

How does Modesto compare?

In Bakersfield, the office rate for 40804 is $222.81—$0.55 higher than the $222.26 rate in Modesto. Both use the same code, release and participation basis.

40804 across payment areas

Same release and payment basis · bars start at $0

  1. Modesto · This locality

    $222.26

  2. Bakersfield

    $222.81

    $0.55 higher than Modesto

  3. Chico

    $222.26

    The same base rate than Modesto

  4. El Centro

    $222.29

    $0.03 higher than Modesto

  5. Fresno

    $222.26

    The same base rate than Modesto

  6. Hanford-Corcoran

    $222.26

    The same base rate than Modesto

  7. Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty)

    $238.04

    $15.78 higher than Modesto

Other payment areas listed in California appear first, followed by selected cross-country examples. The chart compares amounts, not distance.

Across 109 of 109 CMS payment localities with a supported office rate, 40804 ranges from $183.41 in Arkansas to $281.67 in San Jose-Sunnyvale-Santa Clara (San Benito Cnty). This is a geographic range, not an average.

The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.

Compare all 108 other payment areas

  • Madera

    California · 40804

    Office

    $222.26

    Facility

    $119.76

    The same base rate than Modesto for the office setting.

  • Merced

    California · 40804

    Office

    $222.26

    Facility

    $119.76

    The same base rate than Modesto for the office setting.

  • Napa

    California · 40804

    Office

    $259.62

    Facility

    $136.36

    $37.36 higher than Modesto for the office setting.

  • Oxnard-Thousand Oaks-Ventura

    California · 40804

    Office

    $237.06

    Facility

    $126.52

    $14.80 higher than Modesto for the office setting.

  • Redding

    California · 40804

    Office

    $222.26

    Facility

    $119.76

    The same base rate than Modesto for the office setting.

  • Rest Of California

    California · 40804

    Office

    $222.26

    Facility

    $119.76

    The same base rate than Modesto for the office setting.

  • Riverside-San Bernardino-Ontario

    California · 40804

    Office

    $224.31

    Facility

    $121.81

    $2.05 higher than Modesto for the office setting.

  • Sacramento-Roseville-Folsom

    California · 40804

    Office

    $233.80

    Facility

    $125.04

    $11.54 higher than Modesto for the office setting.

  • Salinas

    California · 40804

    Office

    $232.95

    Facility

    $124.56

    $10.69 higher than Modesto for the office setting.

  • San Diego-Chula Vista-Carlsbad

    California · 40804

    Office

    $238.88

    Facility

    $127.03

    $16.62 higher than Modesto for the office setting.

  • San Francisco-Oakland-Berkeley (Marin Cnty)

    California · 40804

    Office

    $275.42

    Facility

    $143.55

    $53.16 higher than Modesto for the office setting.

  • San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)

    California · 40804

    Office

    $275.20

    Facility

    $143.34

    $52.94 higher than Modesto for the office setting.

  • San Jose-Sunnyvale-Santa Clara (San Benito Cnty)

    California · 40804

    Office

    $281.67

    Facility

    $146.81

    $59.41 higher than Modesto for the office setting.

  • San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)

    California · 40804

    Office

    $280.79

    Facility

    $145.93

    $58.53 higher than Modesto for the office setting.

  • San Luis Obispo-Paso Robles

    California · 40804

    Office

    $229.15

    Facility

    $122.63

    $6.89 higher than Modesto for the office setting.

  • Santa Cruz-Watsonville

    California · 40804

    Office

    $241.51

    Facility

    $127.88

    $19.25 higher than Modesto for the office setting.

  • Santa Maria-Santa Barbara

    California · 40804

    Office

    $233.95

    Facility

    $124.90

    $11.69 higher than Modesto for the office setting.

  • Santa Rosa-Petaluma

    California · 40804

    Office

    $243.97

    Facility

    $129.13

    $21.71 higher than Modesto for the office setting.

  • Stockton

    California · 40804

    Office

    $222.26

    Facility

    $119.76

    The same base rate than Modesto for the office setting.

  • Vallejo

    California · 40804

    Office

    $259.31

    Facility

    $136.05

    $37.05 higher than Modesto for the office setting.

  • Visalia

    California · 40804

    Office

    $222.26

    Facility

    $119.76

    The same base rate than Modesto for the office setting.

  • Yuba City

    California · 40804

    Office

    $222.26

    Facility

    $119.76

    The same base rate than Modesto for the office setting.

  • Dc + Md/Va Suburbs

    District of Columbia · 40804

    Office

    $240.64

    Facility

    $130.47

    $18.38 higher than Modesto for the office setting.

  • Miami

    Florida · 40804

    Office

    $225.37

    Facility

    $128.01

    $3.11 higher than Modesto for the office setting.

  • Chicago

    Illinois · 40804

    Office

    $218.41

    Facility

    $124.42

    $3.85 lower than Modesto for the office setting.

  • Manhattan

    New York · 40804

    Office

    $241.50

    Facility

    $132.82

    $19.24 higher than Modesto for the office setting.

  • Alaska*

    Alaska · 40804

    Office

    $237.87

    Facility

    $138.27

    $15.61 higher than Modesto for the office setting.

  • Alabama

    Alabama · 40804

    Office

    $186.29

    Facility

    $104.46

    $35.97 lower than Modesto for the office setting.

  • Arkansas

    Arkansas · 40804

    Office

    $183.41

    Facility

    $103.07

    $38.85 lower than Modesto for the office setting.

  • Arizona

    Arizona · 40804

    Office

    $203.21

    Facility

    $112.58

    $19.05 lower than Modesto for the office setting.

  • Colorado

    Colorado · 40804

    Office

    $218.47

    Facility

    $118.96

    $3.79 lower than Modesto for the office setting.

  • Connecticut

    Connecticut · 40804

    Office

    $223.62

    Facility

    $122.89

    $1.36 higher than Modesto for the office setting.

  • Delaware

    Delaware · 40804

    Office

    $206.74

    Facility

    $114.34

    $15.52 lower than Modesto for the office setting.

  • Fort Lauderdale

    Florida · 40804

    Office

    $216.30

    Facility

    $121.56

    $5.96 lower than Modesto for the office setting.

  • Rest Of Florida

    Florida · 40804

    Office

    $205.23

    Facility

    $115.82

    $17.03 lower than Modesto for the office setting.

  • Atlanta

    Georgia · 40804

    Office

    $213.06

    Facility

    $118.04

    $9.20 lower than Modesto for the office setting.

  • Rest Of Georgia

    Georgia · 40804

    Office

    $192.99

    Facility

    $109.57

    $29.27 lower than Modesto for the office setting.

  • Hawaii, Guam

    Hawaii · 40804

    Office

    $228.38

    Facility

    $122.05

    $6.12 higher than Modesto for the office setting.

  • Iowa

    Iowa · 40804

    Office

    $191.64

    Facility

    $106.06

    $30.62 lower than Modesto for the office setting.

  • Idaho

    Idaho · 40804

    Office

    $192.92

    Facility

    $106.88

    $29.34 lower than Modesto for the office setting.

  • East St. Louis

    Illinois · 40804

    Office

    $202.70

    Facility

    $116.66

    $19.56 lower than Modesto for the office setting.

  • Rest Of Illinois

    Illinois · 40804

    Office

    $198.71

    Facility

    $113.33

    $23.55 lower than Modesto for the office setting.

  • Suburban Chicago

    Illinois · 40804

    Office

    $218.61

    Facility

    $122.57

    $3.65 lower than Modesto for the office setting.

  • Indiana

    Indiana · 40804

    Office

    $194.12

    Facility

    $107.43

    $28.14 lower than Modesto for the office setting.

  • Kansas

    Kansas · 40804

    Office

    $190.55

    Facility

    $106.01

    $31.71 lower than Modesto for the office setting.

  • Kentucky

    Kentucky · 40804

    Office

    $190.75

    Facility

    $107.61

    $31.51 lower than Modesto for the office setting.

  • New Orleans

    Louisiana · 40804

    Office

    $200.49

    Facility

    $112.49

    $21.77 lower than Modesto for the office setting.

  • Rest Of Louisiana

    Louisiana · 40804

    Office

    $190.39

    Facility

    $107.62

    $31.87 lower than Modesto for the office setting.

  • Metropolitan Boston

    Massachusetts · 40804

    Office

    $241.23

    Facility

    $129.57

    $18.97 higher than Modesto for the office setting.

  • Rest Of Massachusetts

    Massachusetts · 40804

    Office

    $216.98

    Facility

    $118.50

    $5.28 lower than Modesto for the office setting.

  • Baltimore/Surr. Cntys

    Maryland · 40804

    Office

    $222.98

    Facility

    $122.63

    $0.72 higher than Modesto for the office setting.

  • Rest Of Maryland

    Maryland · 40804

    Office

    $210.92

    Facility

    $116.27

    $11.34 lower than Modesto for the office setting.

  • Rest Of Maine

    Maine · 40804

    Office

    $193.86

    Facility

    $107.82

    $28.40 lower than Modesto for the office setting.

  • Southern Maine

    Maine · 40804

    Office

    $205.30

    Facility

    $112.62

    $16.96 lower than Modesto for the office setting.

  • Detroit

    Michigan · 40804

    Office

    $207.83

    Facility

    $117.58

    $14.43 lower than Modesto for the office setting.

  • Rest Of Michigan

    Michigan · 40804

    Office

    $195.96

    Facility

    $110.57

    $26.30 lower than Modesto for the office setting.

  • Minnesota

    Minnesota · 40804

    Office

    $209.27

    Facility

    $113.04

    $12.99 lower than Modesto for the office setting.

  • Metropolitan Kansas City

    Missouri · 40804

    Office

    $199.16

    Facility

    $111.35

    $23.10 lower than Modesto for the office setting.

  • Metropolitan St. Louis

    Missouri · 40804

    Office

    $201.41

    Facility

    $112.37

    $20.85 lower than Modesto for the office setting.

  • Rest Of Missouri

    Missouri · 40804

    Office

    $186.80

    Facility

    $106.18

    $35.46 lower than Modesto for the office setting.

  • Mississippi

    Mississippi · 40804

    Office

    $185.15

    Facility

    $104.63

    $37.11 lower than Modesto for the office setting.

  • Montana**

    Montana · 40804

    Office

    $209.08

    Facility

    $115.55

    $13.18 lower than Modesto for the office setting.

  • North Carolina

    North Carolina · 40804

    Office

    $196.06

    Facility

    $108.80

    $26.20 lower than Modesto for the office setting.

  • North Dakota**

    North Dakota · 40804

    Office

    $205.32

    Facility

    $111.80

    $16.94 lower than Modesto for the office setting.

  • Nebraska

    Nebraska · 40804

    Office

    $192.80

    Facility

    $106.48

    $29.46 lower than Modesto for the office setting.

  • New Hampshire

    New Hampshire · 40804

    Office

    $214.87

    Facility

    $117.51

    $7.39 lower than Modesto for the office setting.

  • Northern Nj

    New Jersey · 40804

    Office

    $237.85

    Facility

    $129.36

    $15.59 higher than Modesto for the office setting.

  • Rest Of New Jersey

    New Jersey · 40804

    Office

    $226.15

    Facility

    $124.03

    $3.89 higher than Modesto for the office setting.

  • New Mexico

    New Mexico · 40804

    Office

    $197.06

    Facility

    $111.30

    $25.20 lower than Modesto for the office setting.

  • Nevada**

    Nevada · 40804

    Office

    $208.19

    Facility

    $114.57

    $14.07 lower than Modesto for the office setting.

  • Nyc Suburbs/Long Island

    New York · 40804

    Office

    $247.54

    Facility

    $136.35

    $25.28 higher than Modesto for the office setting.

  • Poughkpsie/N Nyc Suburbs

    New York · 40804

    Office

    $227.56

    Facility

    $125.15

    $5.30 higher than Modesto for the office setting.

  • Queens

    New York · 40804

    Office

    $243.79

    Facility

    $133.24

    $21.53 higher than Modesto for the office setting.

  • Rest Of New York

    New York · 40804

    Office

    $199.19

    Facility

    $110.34

    $23.07 lower than Modesto for the office setting.

  • Ohio

    Ohio · 40804

    Office

    $195.19

    Facility

    $109.81

    $27.07 lower than Modesto for the office setting.

  • Oklahoma

    Oklahoma · 40804

    Office

    $190.52

    Facility

    $107.00

    $31.74 lower than Modesto for the office setting.

  • Portland

    Oregon · 40804

    Office

    $225.94

    Facility

    $122.04

    $3.68 higher than Modesto for the office setting.

  • Rest Of Oregon

    Oregon · 40804

    Office

    $206.56

    Facility

    $113.42

    $15.70 lower than Modesto for the office setting.

  • Metropolitan Philadelphia

    Pennsylvania · 40804

    Office

    $217.65

    Facility

    $120.29

    $4.61 lower than Modesto for the office setting.

  • Rest Of Pennsylvania

    Pennsylvania · 40804

    Office

    $195.59

    Facility

    $109.74

    $26.67 lower than Modesto for the office setting.

  • Puerto Rico

    Puerto Rico · 40804

    Office

    $210.76

    Facility

    $116.21

    $11.50 lower than Modesto for the office setting.

  • Rhode Island

    Rhode Island · 40804

    Office

    $214.50

    Facility

    $117.89

    $7.76 lower than Modesto for the office setting.

  • South Carolina

    South Carolina · 40804

    Office

    $195.95

    Facility

    $109.54

    $26.31 lower than Modesto for the office setting.

  • South Dakota**

    South Dakota · 40804

    Office

    $204.88

    Facility

    $111.35

    $17.38 lower than Modesto for the office setting.

  • Tennessee

    Tennessee · 40804

    Office

    $191.56

    Facility

    $106.55

    $30.70 lower than Modesto for the office setting.

  • Austin

    Texas · 40804

    Office

    $217.75

    Facility

    $118.80

    $4.51 lower than Modesto for the office setting.

  • Beaumont

    Texas · 40804

    Office

    $194.21

    Facility

    $109.10

    $28.05 lower than Modesto for the office setting.

  • Brazoria

    Texas · 40804

    Office

    $206.59

    Facility

    $113.91

    $15.67 lower than Modesto for the office setting.

  • Dallas

    Texas · 40804

    Office

    $207.93

    Facility

    $114.78

    $14.33 lower than Modesto for the office setting.

  • Fort Worth

    Texas · 40804

    Office

    $206.41

    Facility

    $114.20

    $15.85 lower than Modesto for the office setting.

  • Galveston

    Texas · 40804

    Office

    $207.22

    Facility

    $114.35

    $15.04 lower than Modesto for the office setting.

  • Houston

    Texas · 40804

    Office

    $210.69

    Facility

    $117.83

    $11.57 lower than Modesto for the office setting.

  • Rest Of Texas

    Texas · 40804

    Office

    $200.30

    Facility

    $111.54

    $21.96 lower than Modesto for the office setting.

  • Utah

    Utah · 40804

    Office

    $198.82

    Facility

    $110.91

    $23.44 lower than Modesto for the office setting.

  • Virginia

    Virginia · 40804

    Office

    $204.50

    Facility

    $112.57

    $17.76 lower than Modesto for the office setting.

  • Virgin Islands

    United States Virgin Islands · 40804

    Office

    $210.76

    Facility

    $116.21

    $11.50 lower than Modesto for the office setting.

  • Vermont

    Vermont · 40804

    Office

    $204.35

    Facility

    $111.76

    $17.91 lower than Modesto for the office setting.

  • Rest Of Washington

    Washington · 40804

    Office

    $216.62

    Facility

    $118.14

    $5.64 lower than Modesto for the office setting.

  • Seattle (King Cnty)

    Washington · 40804

    Office

    $246.44

    Facility

    $131.69

    $24.18 higher than Modesto for the office setting.

  • Wisconsin

    Wisconsin · 40804

    Office

    $197.96

    Facility

    $108.37

    $24.30 lower than Modesto for the office setting.

  • West Virginia

    West Virginia · 40804

    Office

    $190.82

    Facility

    $109.55

    $31.44 lower than Modesto for the office setting.

  • Wyoming**

    Wyoming · 40804

    Office

    $207.44

    Facility

    $113.92

    $14.82 lower than Modesto for the office setting.

See how rates vary across the country

40804 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.

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 all state and territory rates as a table
State / territoryRate 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

Explore 40804 on the national rate map →

Where does this rate apply?

Modesto is a Medicare payment area. Our Census mapping connects it to 33 cities and communities in California, including the examples shown here.

Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.

Browse all communities in California →

Why are the office and facility amounts different?

For 40804 in Modesto, the physician’s office rate is $222.26 and the facility-setting rate is $119.76: a difference of $102.50.

The calculation uses a different practice-expense RVU for each setting. Both amounts here are physician fee-schedule amounts. The facility figure does not include a hospital’s separate charges, so this comparison does not tell you the total cost of receiving care in each setting.

See the inputs behind this difference →

Use this rate

What is a percentage of Medicare worth?

Turn a percentage into dollars for 40804 in Modesto. This uses the base rate on this page, so the locality and release stay consistent.

Reference amount per service

$244.49

$222.26 × 110% = $244.49

A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.

Working with a whole code list?

Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.

Compare your contract offer →

How this local rate is calculated

Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 40804 in Modesto.

PPRRVU2026_Oct_nonQPP.csv

4,859

Code
40804
Physician work
1.27
Practice expense
4.80
Malpractice
0.19

GPCI2026.csv

16

Locality
Modesto
Physician work
1.017
Practice expense
1.096
Malpractice
0.536
Office / nonfacility calculation for 40804 in Modesto
ComponentRVULocality factorAdjusted
Physician work1.27× 1.0171.2916
Practice expense4.80× 1.0965.2608
Malpractice0.19× 0.5360.1018
Total RVUs6.6542
Conversion factor× 33.4009

Office / nonfacility rate, Modesto$222.26

Values as parsed from CMS release RVU26D, effective 2026-10-01. The amount is rounded to the nearest cent only at the end.

Open 40804 in the RVU calculator →

Explore RVUs, geographic factors and the full formula

Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work1.271.017
Practice expense4.81.096
Malpractice0.190.536

(1.27 × 1.017 + 4.8 × 1.096 + 0.19 × 0.536) × $33.4009 = $222.26

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work1.271.017
Practice expense21.096
Malpractice0.190.536

(1.27 × 1.017 + 2 × 1.096 + 0.19 × 0.536) × $33.4009 = $119.76

The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.

How this rate has changed

40804 · Office / nonfacility

$222.26

Effective 2026-10-01

The base rate is $19.21 higher than on 2025-10-01, moving from $203.05 to $222.26 (9.5%).

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

    $203.05changed to$222.26

    • 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 1.014 changed to 1.017
    • Practice expense GPCI 1.093 changed to 1.096
    • Malpractice GPCI 0.560 changed to 0.536

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    Earliest loaded release: $203.05

    Held through RVU25B, RVU25C, RVU25D.

Explore release dates and calculate this code in an earlier period →

Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.

Inspect every release and its CMS source
Effective fromOffice / nonfacilityFacilityCMS release
2026-10-01$222.26$119.76RVU26D
2026-07-01$222.26$119.76RVU26C
2026-04-01$222.26$119.76RVU26B
2026-01-01$222.26$119.76RVU26A
2025-10-01$203.05$120.67RVU25D
2025-07-01$203.05$120.67RVU25C
2025-04-01$203.05$120.67RVU25B
2025-01-01$203.05$120.67RVU25A

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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.

Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.

RVUs for 40804PPRRVU2026_Oct_nonQPP.csv, line 4,859 (RVU26D)
Geographic factors for ModestoGPCI2026.csv, line 16 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet