Non-Facility
Private Office Rate
$209.09
Effective Q4 2026
Current CMS pricing and breakdown for Removal foreign body mouth.
Non-Facility
Private Office Rate
$209.09
Effective Q4 2026
Facility
Hospital / Outpatient Facility Rate
$115.57
Effective Q4 2026
The amounts shown are the published national payments. Local payment can vary based on your specific Zip Code, GPCI adjustments, and site of service.
Your actual reimbursement depends on your specific Zip Code and GPCI adjustments (e.g., New York vs. Texas).
| Quarter | Non-Facility Rate | Facility Rate | YoY % Change (Non-Fac) | YoY % Change (Fac) |
|---|---|---|---|---|
| 2026 Q4 | $209.09 | $115.57 | +9.19% | -0.47% |
| 2026 Q3 | $209.09 | $115.57 | +9.19% | -0.47% |
| 2026 Q2 | $209.09 | $115.57 | +9.19% | -0.47% |
| 2026 Q1 | $209.09 | $115.57 | +9.19% | -0.47% |
| 2025 Q4 | $191.49 | $116.12 | — | — |
| 2025 Q3 | $191.49 | $116.12 | — | — |
| 2025 Q2 | $191.49 | $116.12 | — | — |
| 2025 Q1 | $191.49 | $116.12 | — | — |
Removal foreign body mouth
CPT code 40804 (Removal foreign body mouth) had a 2026 Medicare non-facility reimbursement rate of $209.09. This reflects a 9.19% change from the prior year. The code carries 6.26 total RVUs across work, practice expense, and malpractice components.
For 2026, the estimated National Average Medicare payment for 40804 is $209.09 in a non-facility (office) setting and $115.57 in a facility (hospital/outpatient) setting. Your actual reimbursement depends on locality adjustments.
This code’s RVU components (Work, Practice Expense, and Malpractice) combine to approximately 6.26 total RVUs in the office setting and 3.46 total RVUs in the facility setting.
Description: Removal foreign body mouth. For locality-adjusted estimates, use MedFeeSchedule's Medicare Physician Fee Schedule Lookup Tool.
| Component | Office (Non-Fac) | Facility (Hosp) |
|---|---|---|
| Work RVU | 1.27 | 1.27 |
| Practice Expense (PE) | 4.8 | 2 |
| Malpractice (MP) | 0.19 | 0.19 |
| Total RVUs | 6.26 | 3.46 |
Compare a payment against the Medicare benchmark for this code.
Medicare rates are used as a benchmark only. Actual payer contracts, modifiers, place of service, units, and billing rules may affect reimbursement. This tool is for educational and operational review purposes, not legal or billing advice.
Medicare often publishes two payment rates for the same code: a **non-facility** rate (typically used when the service is performed in a private office where the clinician bears more overhead) and a **facility** rate (typically used when performed in a hospital or facility where the facility bills separately for its costs).
Because the practice expense portion of RVUs differs by setting, the non-facility and facility payment amounts can be different. For locality-adjusted estimates in 2026, use MedFeeSchedule's Medicare Physician Fee Schedule Lookup Tool.
Medicare reimbursement is determined by RVUs, geographic adjustments, and the annual conversion factor.
The 2026 National Average Medicare reimbursement rate for 40804 (Physician Service) is $209.09. This rate is effective as of January 1, 2026.
Removal foreign body mouth
For many physician services, Medicare publishes different practice-expense RVUs by setting. In general, non-facility rates apply when services are performed in a private office, while facility rates apply when performed in a hospital or facility where the facility bills separately.
Use MedFeeSchedule's Medicare Physician Fee Schedule Lookup Tool on the homepage to estimate your locality-adjusted reimbursement. Medicare payment can vary based on geographic adjustments (GPCI), place of service, and claim specifics.
Coverage depends on medical necessity, setting, and Medicare policy. Some codes may be bundled, contractor-priced, or restricted. Verify final coverage guidance through CMS or your local MAC when applicable.