CPT code 40842: Mouth reconstruction, extensive reconstruction2026 Medicare rate & RVUs

Medicare pays $838.03 for 40842 nationally in the office and $544.43 in a hospital or facility. Local office rates run $746.59–$1,069.28.

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

What 40842 covers

Code 40842 identifies extensive reconstruction of oral tissues, rather than a limited or complicated level. Oral and maxillofacial surgeons and head-and-neck surgeons may perform this work to restore tissues after a mouth defect. The operative report should describe the defect, its extent, and the reconstructive work performed; the code does not identify a single mouth subsite or a particular graft method.

Select the extensive level based on the documented scope of reconstruction and the applicable code distinctions. Medicare payment is restricted to specific circumstances, so the record should support the indication and medical necessity. The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery. In a same-session multiple-procedure claim, the highest-valued procedure is paid in full and the others are subject to a 50% reduction. Modifier 50 is inappropriate. 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 40842 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

40842 rates by state

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

How the 40842 rate is calculated

Each of 40842’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 40842

40842 has a 90-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

40842 compared with similar codes

How to choose

40840Mouth reconstructionAnterior vestibuloplasty

40840 is the limited reconstruction level. Use 40842 when the documented work meets the extensive level.

40843Mouth reconstructionExtensive, with skin graft

40843 is the complicated reconstruction level. Choose between it and 40842 based on the documented scope and complexity.

40844Mouth reconstructionMucosal graft included

40844 is for vestibule reconstruction using a split-thickness skin graft, not the extensive-level service described by 40842.

40845Mouth reconstructionWith bone graft

40845 is for vestibule reconstruction using a full-thickness skin graft, not the extensive-level service described by 40842.

Codes related to 40842

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