$194.59–$206.31
Use 40801 for complicated vestibular drainage and 40800 for the simpler drainage level. The procedure note should support the distinction.
On this page
CMS RVU26D · Effective 2026-10-01
40801 Mouth drainage Medicare reimbursement rates in Maine
Reports incision and drainage of a complicated abscess, cyst, or hematoma in the vestibule of the mouth, rather than simple drainage. Compare 40801 office and facility rates across CMS payment localities in Maine.
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 40801 in Maine?
Maine has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$286.16–$301.20
2 of 2 localities have a supported rate.
Facility setting
$177.69–$184.36
2 of 2 localities have a supported rate.
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 surgery
About 40801: Complicated vestibular mouth drainage
Reports incision and drainage of a complicated abscess, cyst, or hematoma in the vestibule of the mouth, rather than simple drainage.
This service treats a fluid collection such as an abscess, cyst, or hematoma in the vestibule—the space between the lips or cheeks and the teeth or gums. An oral and maxillofacial surgeon, dentist, or otolaryngologist may incise the site and evacuate the collection in an office or facility setting. The clinical purpose is drainage, not tissue sampling or removal of the lesion.
Select this code when the documented procedure meets the complicated level, rather than the simpler drainage represented by 40800. The operative note should identify the collection and vestibular site and describe the incision and drainage performed, with details supporting the level selected. Related postoperative visits during the 10-day global period are included. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service; co-surgeons and team surgery are not permitted.
CMS billing rules for 40801
- 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
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU2.56 · 28%
- Practice expense (office) RVU6.30 · 68%
- Malpractice RVU0.34 · 4%
418
Medicare services in 2024 · #3699 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.
40801 compared with similar codes
Office rates for Maine, from the same CMS release.
$155.90–$165.12
40808 is for biopsy of a mouth lesion. Choose it when tissue is sampled, rather than when a collection is incised and evacuated.
$200.58–$212.39
40810 describes excision of a mouth lesion. It is appropriate when the lesion is removed, not merely drained.
$234.01–$248.50
40820 is for treatment of a mouth lesion by a different treatment approach; 40801 specifically represents complicated drainage of a vestibular collection.
Compare 40801 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.
2 of 2 payment localities
Rest Of Maine →
Office / nonfacility
$286.16
Facility
$177.69
Southern Maine →
Office / nonfacility
$301.20
Facility
$184.36
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40801 billing questions
How is 40801 different from 40800?
40801 is for complicated drainage of a collection in the mouth vestibule; 40800 represents the simpler drainage service. The operative documentation should support the level reported.
Can a biopsy or excision be reported instead?
Use a biopsy code when tissue is sampled for diagnosis, and an excision code when the lesion is removed. Drainage describes incision and evacuation of a collection.
Are related postoperative visits separately billable?
Related postoperative visits during the 10-day global period are included in this service.
Can modifier 50 be used for collections on both sides?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.
How does Medicare handle another procedure in the same session?
The highest-valued procedure is paid in full, and other procedures performed in the same session are subject to the standard multiple-procedure reduction.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this service. 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.
4,85540799,,Unlisted procedure lips,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,0,2,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
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