$195.59–$217.65
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.
On this page
CMS RVU26D · Effective 2026-10-01
40805 Foreign body removal Medicare reimbursement rates in Pennsylvania
Removal of an embedded foreign body from the oral vestibule when the retrieval is complicated, rather than a simple extraction. Compare 40805 office and facility rates across CMS payment localities in Pennsylvania.
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 40805 in Pennsylvania?
Pennsylvania 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
$275.40–$302.98
2 of 2 localities have a supported rate.
Facility setting
$176.67–$191.02
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 40805: Complicated oral vestibule foreign body removal
Removal of an embedded foreign body from the oral vestibule when the retrieval is complicated, rather than a simple extraction.
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.
CMS billing rules for 40805
- 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 RVU2.72 · 31%
- Practice expense (office) RVU5.71 · 65%
- Malpractice RVU0.30 · 3%
33
Medicare services in 2024 · #5598 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.
40805 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
$157.15–$174.82
40808 is for sampling a lesion in the mouth for biopsy. It is not the code for retrieving an embedded foreign object.
$202.19–$224.86
40810 describes excision of a mouth lesion. Choose 40805 when the target is an embedded foreign body, not tissue being excised as a lesion.
Compare 40805 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
Metropolitan Philadelphia →
Office / nonfacility
$302.98
Facility
$191.02
Rest Of Pennsylvania →
Office / nonfacility
$275.40
Facility
$176.67
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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 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.
4,85740800,,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
4,86340810,,Excision of mouth lesion,A,,1.33,4.96,,1.93,,0.18,6.47,3.44,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00