Billing code 41016: Abscess drainageMedicare rate & RVUs in Virginia
Reports operative intraoral drainage of an abscess involving the sublingual, submandibular, or submental space.
Medicare pays $472.56–$551.58 for 41016 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 41016 covers
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.
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 41016 pays more and less in Virginia
| Payment locality | Office | Facility |
|---|---|---|
| Dc + Md/Va Suburbs | $551.58 | $365.08 |
| Virginia | $472.56 | $316.94 |
How the 41016 rate is calculated
Each of 41016’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 · 41016
RVUs × geographic indexes × conversion factor
Work4.09
4.09 RVUs× 1.000 GPCI
Practice expense9.83
9.83 RVUs× 1.000 GPCI
Malpractice0.56
0.56 RVUs× 1.000 GPCI
Adjusted RVUs
14.4800
Conversion factor
$33.4009
Medicare rate
$483.65
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 41016
41016 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 41016
Abscess drainage
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 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) | 0 | Not paid without supporting documentation. |
| 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) | 0.09/0.81/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 41016
Abscess drainage
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
41016 without 51 · national office
$483.65
Abscess drainage
41016-51 · Second procedure: 50%
$241.83
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%).
41016 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 41017Lesion drainage
- Both address the sublingual, submandibular, or submental spaces; choose 41016 for access through the mouth and 41017 for external access.
- 41015Mouth lesion drainage
- 41015 is for external drainage of the masticator space. Code 41016 concerns the sublingual, submandibular, or submental spaces and uses an intraoral route.
- 41005Oral drainage
- 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.
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 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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