$466.65
Both address the sublingual, submandibular, or submental spaces; choose 41016 for access through the mouth and 41017 for external access.
On this page
CMS RVU26D · Effective 2026-10-01
41016 Abscess drainage Medicare reimbursement rates in Vermont
Reports operative intraoral drainage of an abscess involving the sublingual, submandibular, or submental space. Compare 41016 office and facility rates across CMS payment localities in Vermont.
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 41016 in Vermont?
Vermont 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
$471.12
1 of 1 localities have a supported rate.
Payment area: Vermont
One mapped payment locality.
Facility setting
$314.38
1 of 1 localities have a supported rate.
Payment area: Vermont
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 surgery
About 41016: Intraoral submandibular space abscess drainage
Reports operative intraoral drainage of an abscess involving the sublingual, submandibular, or submental space.
Code 41016 describes surgical drainage reached through the mouth for an infection in the sublingual, submandibular, or submental space. Oral and maxillofacial surgeons and otolaryngologists commonly perform it in an operating room when a deep infection requires operative access, rather than drainage of a superficial oral lesion. The documented approach must be intraoral and the involved space must support selection of this code.
Record the affected space, incision route, findings, and drainage performed. The 90-day global period includes the preoperative visit on the day before surgery and related postoperative care for 90 days. 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% reduction. Modifier 50 is not appropriate for this anatomy. An assistant is paid only when medical necessity is documented; co-surgeons and team surgery are not permitted.
CMS billing rules for 41016
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care 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 RVU4.09 · 28%
- Practice expense (office) RVU9.83 · 68%
- Malpractice RVU0.56 · 4%
157
Medicare services in 2024 · #4530 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.
41016 compared with similar codes
Office rates for Vermont, from the same CMS release.
$400.45
41015 is for external drainage of the masticator space. Code 41016 concerns the sublingual, submandibular, or submental spaces and uses an intraoral route.
$226.66
41005 concerns drainage involving the tongue or floor of the mouth. Use 41016 when the documented infection is in the sublingual, submandibular, or submental space.
Compare 41016 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
Vermont →
Office / nonfacility
$471.12
Facility
$314.38
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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 41016 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
4,891
- Code
- 41016
- Physician work
- 4.09
- Practice expense
- 9.83
- Malpractice
- 0.56
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 4.09 | × 1.000 | 4.0900 |
| Practice expense | 9.83 | × 0.990 | 9.7317 |
| Malpractice | 0.56 | × 0.506 | 0.2834 |
| Total RVUs | 14.1051 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Vermont$471.12
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.09 | 1 |
| Practice expense | 9.83 | 0.99 |
| Malpractice | 0.56 | 0.506 |
(4.09 × 1 + 9.83 × 0.99 + 0.56 × 0.506) × $33.4009 = $471.12
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.09 | 1 |
| Practice expense | 5.09 | 0.99 |
| Malpractice | 0.56 | 0.506 |
(4.09 × 1 + 5.09 × 0.99 + 0.56 × 0.506) × $33.4009 = $314.38
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.
41016 billing questions
How is 41016 distinguished from 41017?
41016 is for drainage through an intraoral approach. Use 41017 when the surgeon reaches the sublingual, submandibular, or submental space externally.
Does the note need to identify the space and approach?
Yes. Document the involved anatomic space and that drainage was performed through an intraoral incision.
Can modifier 50 be reported?
No. The anatomy is represented by a single procedure code, not a bilateral modifier 50 claim.
How does the 90-day global period affect follow-up billing?
The day-before preoperative visit and related postoperative care for 90 days are included in the global period.
Can an assistant surgeon be reported?
Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeons and team surgery are not permitted for this code.
What happens when another procedure is performed in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction.
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.
4,8884100F,,Biphos thxpy vein ord/recvd,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
4,88941010,,Incision of tongue fold,A,,1.08,5.07,,1.83,,0.16,6.31,3.07,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,89041015,,Drainage of mouth lesion,A,,3.98,7.86,,3.95,,0.45,12.29,8.38,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,89141016,,Drainage of mouth lesion,A,,4.09,9.83,,5.09,,0.56,14.48,9.74,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,89241017,,Drainage of mouth lesion,A,,4.09,9.70,,4.98,,0.55,14.34,9.62,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,89341018,,Drainage of mouth lesion,A,,5.09,10.62,,5.42,,0.71,16.42,11.22,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,89441019,,Place needles h&n for rt,A,,8.62,2.85,NA,2.85,,0.68,12.15,12.15,0,000,0.00,0.00,0.00,2,0,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817