CPT code 40831: Laceration repair, complicated vestibular wound2026 Medicare rate & RVUs

Medicare pays $312.63 for 40831 nationally in the office and $193.39 in a hospital or facility. Local office rates run $276.47–$412.69.

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

What 40831 covers

This service repairs a complicated traumatic wound in the oral vestibule, the space between the lips or cheeks and the teeth or gums. It may be performed by an oral and maxillofacial surgeon, otolaryngologist, plastic surgeon, or emergency physician in an office, emergency department, or other appropriate setting. The procedure closes the injured tissue; it is not removal of a mouth lesion or drainage of an abscess.

Choose this code rather than 40830 when the documented laceration requires complicated repair. Record the site, wound extent and tissue involvement, and the repair performed to support that distinction. Medicare assigns a 10-day global period, so related postoperative visits during that period are included. 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. Do not use modifier 50 for this service. 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 40831 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

40831 rates by state

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

How the 40831 rate is calculated

Each of 40831’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.

Payment rules and modifiers for 40831

40831 has a 10-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 51

40831 compared with similar codes

How to choose

40830Mouth laceration repairSimple vestibular repair

This code is for complicated repair; 40830 is for simple repair of a mouth vestibule laceration.

40812Oral lesion excisionSimple repair

40812 concerns excision and repair of a mouth lesion. Use 40831 for repair of a traumatic laceration, not a lesion excision.

40840Mouth reconstructionAnterior vestibuloplasty

40840 describes reconstruction of the mouth. Choose 40831 when the service is closure of a complicated laceration rather than mouth reconstruction.

Codes related to 40831

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

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

Open CMS sourceHow we calculate rates