Billing code 40804: Foreign body removalMedicare rate & RVUs in Washington
Reports straightforward removal of a foreign object from inside the mouth, such as an object lodged in oral soft tissue and extracted without extensive dissection.
Medicare pays $216.62–$246.44 for 40804 in the office in Washington, from Rest Of Washington to Seattle (King Cnty). 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 40804 covers
This service covers a straightforward extraction of a foreign object from inside the mouth. A physician, dentist, or other qualified practitioner may perform it in an office, emergency department, or operating setting when an object is lodged in oral tissue and can be removed without extensive dissection. Examples may include a small fragment embedded in the cheek or gum tissue. The key distinction from 40805 is the complexity of the removal, not simply the object’s identity.
Report 40804 when the documented work supports a simple intraoral extraction; describe the object’s location and the steps used to remove it. Related postoperative visits during the 10-day global period are included. If other procedures occur in the same session, the highest-valued procedure is paid in full and the others are subject to the standard 50% multiple-procedure reduction. Do not use modifier 50 for bilateral removal. Assistant-at-surgery payment requires documented medical necessity; 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 40804 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | $216.62 | $118.14 |
| Seattle (King Cnty) | $246.44 | $131.69 |
How the 40804 rate is calculated
Each of 40804’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 · 40804
RVUs × geographic indexes × conversion factor
Work1.27
1.27 RVUs× 1.000 GPCI
Practice expense4.80
4.80 RVUs× 1.000 GPCI
Malpractice0.19
0.19 RVUs× 1.000 GPCI
Adjusted RVUs
6.2600
Conversion factor
$33.4009
Medicare rate
$209.09
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 40804
40804 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 40804
Foreign body removal
| 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) | 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) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 40804
Foreign body removal
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
40804 without 51 · national office
$209.09
Foreign body removal
40804-51 · Second procedure: 50%
$104.55
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%).
40804 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 40805Foreign body removal
- Choose 40804 for a simple extraction and 40805 when the removal is complicated. The operative note should support the level of difficulty.
- 40800Oral drainage
- 40800 is for draining a mouth lesion, not extracting an object. Report it with 40804 only when distinct drainage is performed.
- 40808Mouth biopsy
- 40808 is used to biopsy an oral lesion. Removing a foreign object is not a biopsy unless separate tissue sampling is performed.
- 40830Mouth laceration repair
- 40830 repairs a mouth laceration. Use it for distinct wound repair, rather than for the extraction itself.
40804 billing questions
How do I choose 40804 rather than 40805?
Use 40804 for a simple intraoral extraction. Use 40805 when the documented removal is complicated; the distinction is the complexity of the extraction.
Can removal of a foreign object be reported with drainage of an oral lesion?
A separate drainage service may be reported when a lesion is independently drained and the work is documented. Do not report drainage merely for extracting the object.
Are postoperative visits billed separately?
Related postoperative visits during the 10-day global period are included in 40804.
Should modifier 50 be used for objects on both sides of the mouth?
No. CMS bilateral adjustment does not apply to this service, and modifier 50 is inappropriate.
What supports reporting 40804?
Document the foreign object’s intraoral location and the removal performed, including enough detail to support a simple rather than complicated extraction.
Can an assistant or another surgeon be paid for the procedure?
Assistant-at-surgery payment requires documentation of medical necessity. 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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