CPT code 40800: Oral drainage2026 Medicare rate & RVUs in Virginia
Reports simple drainage of a localized collection in the mouth’s vestibule, such as an abscess along the inner lip or cheek near the teeth.
Medicare pays $205.39–$241.78 for 40800 in the office in Virginia, from Virginia to Dc + Md/Va Suburbs. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 40800 covers
CPT 40800 covers a simple procedure to open and empty a localized fluid collection in the oral vestibule, the space between the lips or cheeks and the teeth and gums. A typical case is a small abscess along the inner lip or cheek beside the dental arch. An oral and maxillofacial surgeon or another clinician treating oral disease may perform the service in an office or facility. This is drainage, not diagnostic tissue sampling, foreign-body removal, or excision of a lesion.
Select 40800 when the documented work supports simple drainage; 40801 is the related code for complicated drainage. Document the collection’s precise vestibular location and the drainage performed. The 10-day global period includes related postoperative visits during that period. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and the others at 50%. Modifier 50 is inappropriate. Assistant-at-surgery services are not paid, and co-surgeons and team surgery are not permitted.
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.
Where 40800 pays more and less in Virginia
| Payment locality | Office | Facility |
|---|---|---|
| Dc + Md/Va Suburbs | $241.78 | $131.21 |
| Virginia | $205.39 | $113.13 |
How the 40800 rate is calculated
Each of 40800’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 40800
RVUs × geographic indexes × conversion factor
Work1.20
1.20 RVUs× 1.000 GPCI
Practice expense4.92
4.92 RVUs× 1.000 GPCI
Malpractice0.16
0.16 RVUs× 1.000 GPCI
Adjusted RVUs
6.2800
Conversion factor
$33.4009
Medicare rate
$209.76
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 40800
40800 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 40800
Oral drainage
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 40800
Oral drainage
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
40800 without 51 · national office
$209.76
Oral drainage
40800-51 · Second procedure: 50%
$104.88
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
40800 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 40801Mouth drainage
- Both address drainage in the oral vestibule. Choose 40800 for simple drainage and 40801 when the documented procedure is complicated.
- 40808Mouth biopsy
- 40808 describes tissue sampling of a vestibular lesion; 40800 describes draining a fluid collection.
- 40810Mouth lesion excision
- 40810 is for excising a vestibular lesion. Use 40800 when the service opens and drains a collection instead.
- 40804Foreign body removal
- 40804 is for simple removal of a foreign body from the vestibule, not drainage of an abscess or other collection.
40800 billing questions
How is 40800 distinguished from 40801?
40800 is for simple drainage in the oral vestibule; 40801 is for complicated drainage. The procedure note should support the level selected.
When is a biopsy code more appropriate?
Use 40808 when the service is a biopsy of a vestibular lesion for tissue diagnosis, rather than simple drainage of a collection.
Can modifier 50 be used for collections on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code.
Are related postoperative visits separately payable during the global period?
Related postoperative visits during the 10-day global period are included in the procedure.
Can an assistant or co-surgeon be paid for this procedure?
Assistant-at-surgery services are not paid for this code. 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 indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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