$288.74
Choose 40804 for a simple extraction and 40805 when the removal is complicated. The operative note should support the level of difficulty.
On this page
CMS RVU26D · Effective 2026-10-01
40804 Foreign body removal Medicare reimbursement rates in Delaware
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. Compare 40804 office and facility rates across CMS payment localities in Delaware.
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.
What does Medicare pay for 40804 in Delaware?
Delaware has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$206.74
1 of 1 localities have a supported rate.
Payment area: Delaware
One mapped payment locality.
Facility setting
$114.34
1 of 1 localities have a supported rate.
Payment area: Delaware
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
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 Delaware, from the same CMS release.
$207.45
40800 is for draining a mouth lesion, not extracting an object. Report it with 40804 only when distinct drainage is performed.
$166.15
40808 is used to biopsy an oral lesion. Removing a foreign object is not a biopsy unless separate tissue sampling is performed.
$229.34
40830 repairs a mouth laceration. Use it for distinct wound repair, rather than for the extraction itself.
Compare 40804 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Delaware →
Office / nonfacility
$206.74
Facility
$114.34
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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 Delaware.
PPRRVU2026_Oct_nonQPP.csv
4,859
- Code
- 40804
- Physician work
- 1.27
- Practice expense
- 4.80
- Malpractice
- 0.19
GPCI2026.csv
40
- Locality
- Delaware
- Physician work
- 1.005
- Practice expense
- 0.988
- Malpractice
- 0.899
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.27 | × 1.005 | 1.2763 |
| Practice expense | 4.80 | × 0.988 | 4.7424 |
| Malpractice | 0.19 | × 0.899 | 0.1708 |
| Total RVUs | 6.1896 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Delaware$206.74
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.27 | 1.005 |
| Practice expense | 4.8 | 0.988 |
| Malpractice | 0.19 | 0.899 |
(1.27 × 1.005 + 4.8 × 0.988 + 0.19 × 0.899) × $33.4009 = $206.74
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.27 | 1.005 |
| Practice expense | 2 | 0.988 |
| Malpractice | 0.19 | 0.899 |
(1.27 × 1.005 + 2 × 0.988 + 0.19 × 0.899) × $33.4009 = $114.34
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.
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.
4,8564079F,,Doc rehab svcs considered,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
4,85740800,,Drainage of mouth lesion,A,,1.20,4.92,,2.11,,0.16,6.28,3.47,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,85840801,,Drainage of mouth lesion,A,,2.56,6.30,,2.77,,0.34,9.20,5.67,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,85940804,,Removal foreign body mouth,A,,1.27,4.80,,2.00,,0.19,6.26,3.46,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,86040805,,Removal foreign body mouth,A,,2.72,5.71,,2.49,,0.30,8.73,5.51,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,86140806,,Incision of lip fold,A,,0.30,2.67,,0.50,,0.06,3.03,0.86,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,86240808,,Biopsy of mouth lesion,A,,1.02,3.87,,1.31,,0.14,5.03,2.47,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808
4209102,FL,04,MIAMI,1.000,1.041,2.529
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503