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See a sample rate comparisonCPT 40804 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Removal Of Embedded Foreign B, Removal Of Embedded Foreign Body Vestibule Of Mouthsimple Removal Of Embedded Foreign Body Vestibule Of Mouth
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 11 - Office 23 - Emergency Room |
| Common Modifiers | UA AG - Primary physician |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $209.09 national non-facility rate (2026) · View Medicare rates for 40804 |
| Medicaid Fee Schedule | $163.87 median of the 8 states in the free preview · View Medicaid rates for 40804 |
National average reimbursement for CPT 40804 by major payers:
$228.36
$258.94
$265.59
$310.51
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CPT 40804
5 of 25 sample ratesHigher to lower in this preview
Rockwall Ambulatory Surgery Center LLP, Baylor Scott & White Surgicare - Rockwall
$1,955.00Published rateSilver Cross Ambulatory Surgery Center, LLC, Silver Cross Surgery Center
Silver Cross Ambulatory Surgery Center LLC
$1,233.00Published rateSurgcenter Of Northern Baltimore, LLC
Surgcenter Of Northern Baltimore LLC
$788.00Published rateSurgery Center Jv, The Surgery Center Of Huntsville
The Surgery Center Of Huntsville
$508.00Published rateEye Surgery Limited LLC, Virginia Center For Eye Surgery
Eye Surgery Limited, LLC
$396.00Published rate
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See a sample payer proposalCPT 40804 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 40804 code is part of the Surgery services used for Surgical Procedures on the Digestive System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 40804 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 40800-CPT | Moderate | Drainage Of Abscess In Mouth, Surgery To Drain Blood Pus Or Fluid From An Abscess (Pocket Of Infection) Hematoma (Collection Of Blood Under The Skin) Or Cyst (Pocket Of Fluid) Within The Mouth. |
| 40801-CPT | Moderate | Drainage Of Abscess In Mouth, Surgery To Drain Blood Pus Or Fluid From An Abscess (Pocket Of Infection) Hematoma (Collection Of Blood Under The Skin) Or Cyst (Pocket Of Fluid) Within The Mouth. |
| 40804-CPT | Moderate | Removal Of Embedded Foreign B, Removal Of Embedded Foreign Body Vestibule Of Mouthsimple Removal Of Embedded Foreign Body Vestibule Of Mouth |
| 40805-CPT | Moderate | Removal Of Embedded Foreign Bo, Removal Of Embedded Foreign Body Vestibule Of Mouthcomplicated Removal Of Embedded Foreign Body Vestibule Of Mouth |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 40804. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 40804 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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