CPT code 40842: Mouth reconstruction, extensive reconstruction2026 Medicare rate & RVUs in Maryland
Reports extensive reconstruction of oral tissues when the documented scope meets the extensive level rather than a limited or complicated level.
Medicare pays $843.31–$947.37 for 40842 in the office in Maryland, from Rest of Maryland to Washington, DC area. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
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 in Maryland
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$843.31 to $947.37
| Payment locality | Office | Facility |
|---|---|---|
| Baltimore area, MD | $889.51 | $574.48 |
| Rest of Maryland | $843.31 | $546.20 |
| Washington, DC area | $947.37 | $601.51 |
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.
How the rate is built · 40842
RVUs × geographic indexes × conversion factor
Work8.92
8.92 RVUs× 1.000 GPCI
Practice expense14.84
14.84 RVUs× 1.000 GPCI
Malpractice1.33
1.33 RVUs× 1.000 GPCI
Adjusted RVUs
25.0900
Conversion factor
$33.4009
Medicare rate
$838.03
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 40842
40842 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 40842
Mouth reconstruction, extensive reconstruction
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.09/0.81/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 40842
Mouth reconstruction, extensive reconstruction
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.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
40842 without 51 · national office
$838.03
Mouth reconstruction, extensive reconstruction
40842-51 · Second procedure: 50%
$419.02
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%).
40842 compared with similar codes
Compare codes · National
5 codes, side by side
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.
40842 billing questions
How does this code differ from 40840?
40840 represents limited reconstruction; 40842 is for the extensive level. The operative report should support the level selected.
How does this code differ from 40843?
40843 represents the complicated level. Choose the level supported by the documented scope and complexity of the reconstruction.
Can modifier 50 be used for bilateral work?
No. CMS identifies bilateral adjustment as inappropriate for this code.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures in the same session are subject to a 50% multiple-procedure reduction.
What documentation supports Medicare payment?
Document the indication, the defect and its extent, and the reconstruction performed. Medicare payment is restricted to specific circumstances.
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
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