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CPT code 14040: Tissue rearrangement, defined sites, 10 cm² or less2026 Medicare rate & RVUs in Puerto Rico

Reports local tissue rearrangement for a defect of 10 cm² or less on specified facial, neck, axillary, genital, hand, or foot sites.

CMS RVU26DEffective Oct 1, 2026One payment locality63.8K Medicare services in 2024

In Puerto Rico, Medicare pays $771.65 for 14040 in the office and $548.10 when it’s performed in a hospital or facility.

$771.65Office (non-facility)
$548.10Hospital or facility
+0.6%vs the national office rate ($767.22)

Check a contract rate as a % of Medicare · 14040 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 14040 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 14040 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 14040 covers

The surgeon moves and reshapes nearby skin and underlying tissue to repair a surgical defect, using a local flap such as an advancement or rotation flap. Common situations include reconstructing a cheek or forehead defect after skin cancer removal, or closing a defect on the hand or foot when direct closure is unsuitable. The code covers the forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and feet; other anatomic groups have separate codes.

Choose this level by the total area of the primary and secondary defects, which must be 10 cm² or less. The operative report should identify the site, defect dimensions, flap design, and tissue movement. Excision of the lesion and closure of that defect are included, not separately reported. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur in one session, the highest-valued is paid in full and others at 50%. Modifier 50 is inappropriate for this defined service. Medicare does not pay an assistant at surgery; 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.

How Puerto Rico compares for 14040

Across 109 of 109 payment localities, the office rate for 14040 runs from $686.26 in Arkansas to $980.91 in San Benito County, CA. Puerto Rico pays $771.65. The RVUs are the same everywhere; the geographic indexes change the dollars.

14040 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$771.65
  2. Los Angeles, CA · California$849.28+$77.63
  3. Washington, DC area · District of Columbia$866.71+$95.06
  4. Miami, FL · Florida$840.36+$68.71
  5. Chicago, IL · Illinois$817.72+$46.07
  6. Manhattan, NY · New York$879.20+$107.55
  7. Alaska · Alaska$920.62+$148.97

Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.

Every other payment area

14040 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$695.30$501.83
ArkansasArkansas$686.26$496.32
ArizonaArizona$748.08$533.82
Bakersfield, CACalifornia$801.89$559.55
Chico, CACalifornia$798.72$556.38
El Centro, CACalifornia$798.90$556.56
Fresno, CACalifornia$798.72$556.38
Hanford, CACalifornia$798.72$556.38

14040 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$686.26

$920.62

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
14040 office rate range by state
State / territoryOffice rate rangeLocalities
AK$920.621
AL$695.301
AR$686.261
AZ$748.081
CA$798.72–$980.9129
CO$791.631
CT$815.071
DC$866.711
DE$759.601
FL$765.34–$840.363
GA$725.35–$782.462
GU$813.991
HI$813.991
IA$707.311
ID$712.281
IL$748.08–$817.724
IN$715.911
KS$706.171
KY$714.091
LA$713.82–$745.462
MA$788.36–$862.322
MD$772.51–$866.713
ME$717.61–$749.972
MI$732.57–$775.942
MN$755.141
MO$704.02–$745.633
MS$695.171
MT$767.151
NC$724.081
ND$745.991
NE$710.241
NH$781.251
NJ$823.41–$859.502
NM$736.951
NV$761.701
NY$734.04–$901.075
OH$728.251
OK$710.971
OR$754.80–$812.642
PA$728.25–$797.662
PR$771.651
RI$783.571
SC$727.561
SD$743.491
TN$709.611
TX$724.07–$789.888
UT$736.501
VA$749.04–$866.712
VI$771.651
VT$745.051
WA$786.24–$877.122
WI$723.531
WV$723.511
WY$757.931

See 14040 in every payment locality

How the 14040 rate is calculated

Each of 14040’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 · 14040

RVUs × geographic indexes × conversion factor

Office or facility?

Work8.39

8.39 RVUs× 1.000 GPCI

Practice expense13.51

13.51 RVUs× 1.000 GPCI

Malpractice1.07

1.07 RVUs× 1.000 GPCI

Adjusted RVUs

22.9700

Conversion factor

$33.4009

Medicare rate

$767.22

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Puerto Rico inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

1,451

Code
14040
Physician work
8.39
Practice expense
13.51
Malpractice
1.07

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 14040 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work8.39× 1.0008.3900
Practice expense13.51× 1.01113.6586
Malpractice1.07× 0.9851.0539
Total RVUs23.1026
Conversion factor× 33.4009

Office rate, Puerto Rico$771.65

Office: (8.39 × 1 + 13.51 × 1.011 + 1.07 × 0.985) × $33.4009 = $771.65

Facility: (8.39 × 1 + 6.89 × 1.011 + 1.07 × 0.985) × $33.4009 = $548.10

Open 14040 in the RVU calculator

Payment rules and modifiers for 14040

14040 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 14040

Tissue rearrangement, defined sites, 10 cm² or less

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.71/0.19Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 14040

Tissue rearrangement, defined sites, 10 cm² or less

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.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

14040 without 51 · national office

$767.22

Tissue rearrangement, defined sites, 10 cm² or less

14040-51 · Second procedure: 50%

$383.61

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%).

When to use modifier 51

Codes related to 14040

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 14040
CodeHow it relatesOffice range, Puerto Rico
Same family
14041Tissue rearrangement, 10.1–30 sq cm, specified sitesSame anatomic group; used when the total defect area is 10.1–30 cm².$931.40
Used instead
14000Tissue transfer, trunk, defect up to 10 sq cmFor a small defect on the trunk rather than a site covered by 14040.$671.46
14020Tissue rearrangement, scalp, arm, or leg; up to 10 sq cmFor a small defect on the scalp, arms, or legs.$721.89
14060Local flap repair, eyelid, nose, ear, or lip up to 10 cm²For a small defect involving the eyelids, nose, ears, or lips.$776.15

How 14040 has changed in Puerto Rico

14040 · Office / nonfacility

$771.65

Effective 2026-10-01

The base rate is $24.67 higher than on 2025-10-01, moving from $746.98 to $771.65 (3.3%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $746.98changed to$771.65

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 8.60 changed to 8.39
    • Practice expense RVU 13.31 changed to 13.51
    • Malpractice RVU 1.11 changed to 1.07
    • Practice expense GPCI 1.007 changed to 1.011
    • Malpractice GPCI 0.982 changed to 0.985

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $765.35changed to$746.98

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 13.20 changed to 13.31
    • Malpractice RVU 1.12 changed to 1.11

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $752.86changed to$765.35

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $772.85changed to$752.86

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 13.02 changed to 13.20
    • Malpractice RVU 1.10 changed to 1.12
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $769.92changed to$772.85

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984

  6. January 1, 2023

    RVU23A

    $776.10changed to$769.92

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 12.68 changed to 13.02
    • Malpractice RVU 1.06 changed to 1.10
    • Practice expense GPCI 1.008 changed to 1.000
    • Malpractice GPCI 0.986 changed to 1.000

    Held through RVU23B, RVU23C.

  7. January 1, 2022

    RVU22A

    $775.52changed to$776.10

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 12.51 changed to 12.68
    • Malpractice RVU 1.03 changed to 1.06

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $781.10changed to$775.52

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 11.95 changed to 12.51
    • Malpractice RVU 1.01 changed to 1.03
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $784.58changed to$781.10

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 11.83 changed to 11.95
    • Malpractice RVU 1.27 changed to 1.01
    • Practice expense GPCI 1.007 changed to 1.008
    • Malpractice GPCI 0.990 changed to 0.988

    Held through RVU20B, RVU20C, RVU20D.

  10. January 1, 2019

    RVU19A

    $783.70changed to$784.58

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 11.81 changed to 11.83
    • Malpractice RVU 1.29 changed to 1.27

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $700.87changed to$783.70

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 11.80 changed to 11.81
    • Practice expense GPCI 0.856 changed to 1.007
    • Malpractice GPCI 0.642 changed to 0.990

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $618.15changed to$700.87

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 11.75 changed to 11.80
    • Malpractice RVU 1.30 changed to 1.29
    • Practice expense GPCI 0.705 changed to 0.856
    • Malpractice GPCI 0.293 changed to 0.642

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $619.54changed to$618.15

    • Conversion factor 35.9335 changed to 35.8043
    • Malpractice RVU 1.22 changed to 1.30

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $616.45changed to$619.54

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $607.37changed to$616.45

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 11.58 changed to 11.75
    • Malpractice RVU 1.26 changed to 1.22
    • Practice expense GPCI 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    $602.97changed to$607.37

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 12.97 changed to 11.58
    • Malpractice RVU 1.32 changed to 1.26
    • Practice expense GPCI 0.678 changed to 0.692
    • Malpractice GPCI 0.249 changed to 0.271

    Held through RVU14B, RVU14C, RVU14D.

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: $602.97

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$771.65$548.10RVU26D
2026-07-01$771.65$548.10RVU26C
2026-04-01$771.65$548.10RVU26B
2026-01-01$771.65$548.10RVU26A
2025-10-01$746.98$612.78RVU25D
2025-07-01$746.98$612.78RVU25C
2025-04-01$746.98$612.78RVU25B
2025-01-01$746.98$612.78RVU25A
2024-10-01$765.35$624.90RVU24D
2024-07-01$765.35$624.90RVU24C
2024-04-01$765.35$624.90RVU24B
2024-03-09$765.35$624.90RVU24AR
2024-01-01$752.86$614.70RVU24A
2023-10-01$772.85$630.07RVU23D
2023-07-01$769.92$628.27RVU23C
2023-04-01$769.92$628.27RVU23B
2023-01-01$769.92$628.27RVU23A
2022-10-01$776.10$631.33RVU22D
2022-07-01$776.10$631.33RVU22C
2022-04-01$776.10$631.33RVU22B
2022-01-01$776.10$631.33RVU22A
2021-10-01$775.52$631.67RVU21D
2021-07-01$775.52$631.67RVU21C
2021-04-01$775.52$631.67RVU21B
2021-01-01$775.52$631.67RVU21A
2020-10-01$781.10$645.41RVU20D
2020-07-01$781.10$645.41RVU20C
2020-04-01$781.10$645.41RVU20B
2020-01-01$781.10$645.41RVU20A
2019-10-01$784.58$653.93RVU19D
2019-07-01$784.58$653.93RVU19C
2019-04-01$784.58$653.93RVU19B
2019-01-01$784.58$653.93RVU19A
2018-10-01$783.70$655.73RVU18D
2018-07-01$783.70$655.73RVU18C
2018-04-01$783.70$655.73RVU18B
2018-01-01$783.70$655.73RVU18AR1
2017-10-01$700.87$593.96RVU17D
2017-07-01$700.87$593.96RVU17C
2017-04-01$700.87$593.96RVU17B
2017-01-01$700.87$593.96RVU17A
2016-10-01$618.15$530.56RVU16D
2016-07-01$618.15$530.56RVU16C
2016-04-01$618.15$530.56RVU16B
2016-01-01$618.15$530.56RVU16A
2015-10-01$619.54$531.63RVU15D
2015-07-01$619.54$531.63RVU15C
2015-04-01$616.45$528.99RVU15B
2015-01-01$616.45$528.99RVU15A
2014-10-01$607.37$523.09RVU14D
2014-07-01$607.37$523.09RVU14C
2014-04-01$607.37$523.09RVU14B
2014-01-01$607.37$523.09RVU14A
2013-10-01$602.97$513.93RVU13D
2013-07-01$602.97$513.93RVU13C
2013-04-01$602.97$513.93RVU13B
2013-01-01$602.97$513.93RVU13AR

Price 14040 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

  • Aceitunas
  • Adjuntas
  • Aguada
  • Aguadilla
  • Aguas Buenas
  • Aguas Claras
  • Aguilita
  • Aibonito

Browse all communities in Puerto Rico

14040 billing questions

When should 14040 be chosen over 14041?

Use 14040 when the total primary and secondary defect area is 10 cm² or less at a site covered by this code. Use 14041 when that area is 10.1–30 cm².

Can the lesion excision be billed separately?

Excision of the lesion and closure of the resulting defect are included in the tissue rearrangement service. Do not separately report the excision or a closure for that same defect.

How should the defect area be documented?

Document the defect dimensions and total area, including the primary defect and the secondary defect created for flap movement. Also identify the anatomic site and flap technique.

Can modifier 50 be used for bilateral sites?

No. The defined anatomy and descriptor make modifier 50 inappropriate for this code.

What postoperative care is included?

Medicare assigns a 90-day global period. It includes the day-before preoperative visit and 90 days of related postoperative care.

Can an assistant surgeon or co-surgeon be reported?

Medicare does not pay an assistant at surgery for this service. 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
RVUs for 14040PPRRVU2026_Oct_nonQPP.csv, line 1,451 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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