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

Reports extensive reconstruction of oral tissues when the documented scope meets the extensive level rather than a limited or complicated level.

CMS RVU26DEffective Oct 1, 2026One payment locality129 Medicare services in 2024

In Puerto Rico, Medicare pays $842.81 for 40842 in the office and $545.99 when it’s performed in a hospital or facility.

$842.81Office (non-facility)
$545.99Hospital or facility
+0.6%vs the national office rate ($838.03)

Check a contract rate as a % of Medicare · 40842 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 40842 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 40842 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 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.

How Puerto Rico compares for 40842

Across 109 of 109 payment localities, the office rate for 40842 runs from $746.59 in Arkansas to $1,069.28 in San Benito County, CA. Puerto Rico pays $842.81. The RVUs are the same everywhere; the geographic indexes change the dollars.

40842 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$842.81
  2. Los Angeles, CA · California$926.03+$83.22
  3. Washington, DC area · District of Columbia$947.37+$104.56
  4. Miami, FL · Florida$926.27+$83.46
  5. Chicago, IL · Illinois$900.12+$57.31
  6. Manhattan, NY · New York$963.43+$120.62
  7. Alaska · Alaska$999.27+$156.46

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

Every other payment area

40842 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$756.79$499.90
ArkansasArkansas$746.59$494.40
ArizonaArizona$816.27$531.77
Bakersfield, CACalifornia$873.90$552.13
Chico, CACalifornia$870.07$548.29
El Centro, CACalifornia$870.29$548.51
Fresno, CACalifornia$870.07$548.29
Hanford, CACalifornia$870.07$548.29

40842 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.

$746.59

$999.27

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

View every state and territory as a table
40842 office rate range by state
State / territoryOffice rate rangeLocalities
AK$999.271
AL$756.791
AR$746.591
AZ$816.271
CA$870.07–$1,069.2829
CO$863.601
CT$891.481
DC$947.371
DE$829.081
FL$838.56–$926.273
GA$793.03–$855.782
GU$887.231
HI$887.231
IA$769.111
ID$774.961
IL$819.92–$900.124
IN$779.011
KS$768.411
KY$779.231
LA$779.16–$814.832
MA$860.05–$941.522
MD$843.31–$947.373
ME$781.58–$817.182
MI$800.64–$851.152
MN$821.131
MO$768.47–$814.333
MS$757.541
MT$837.941
NC$788.781
ND$811.641
NE$772.231
NH$852.801
NJ$899.86–$939.132
NM$805.821
NV$831.111
NY$800.05–$988.855
OH$795.261
OK$775.091
OR$822.85–$886.442
PA$794.94–$872.292
PR$842.811
RI$855.251
SC$793.691
SD$808.531
TN$772.351
TX$790.26–$862.318
UT$803.761
VA$816.54–$947.372
VI$842.811
VT$811.131
WA$857.56–$957.312
WI$786.471
WV$792.241
WY$826.481

See 40842 in every payment locality

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

Office or facility?

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.

The exact Puerto Rico inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

4,873

Code
40842
Physician work
8.92
Practice expense
14.84
Malpractice
1.33

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 40842 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work8.92× 1.0008.9200
Practice expense14.84× 1.01115.0032
Malpractice1.33× 0.9851.3101
Total RVUs25.2333
Conversion factor× 33.4009

Office rate, Puerto Rico$842.81

Office: (8.92 × 1 + 14.84 × 1.011 + 1.33 × 0.985) × $33.4009 = $842.81

Facility: (8.92 × 1 + 6.05 × 1.011 + 1.33 × 0.985) × $33.4009 = $545.99

Open 40842 in the RVU calculator

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

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)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.09/0.81/0.10Share 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.

  • 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

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%).

When to use modifier 51

Codes related to 40842

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

Codes related to 40842
CodeHow it relatesOffice range, Puerto Rico
Same family
40840Mouth reconstruction, anterior vestibuloplastyLimited reconstruction level; select based on the documented scope.$888.71
40843Mouth reconstruction, extensive, with skin graftComplicated reconstruction level; select based on documented scope and complexity.$1,301.93
Used instead
40844Mouth reconstruction, mucosal graft includedFor vestibule reconstruction using a split-thickness skin graft.$1,631.13
40845Mouth reconstruction, with bone graftFor vestibule reconstruction using a full-thickness skin graft.$1,483.91

How 40842 has changed in Puerto Rico

40842 · Office / nonfacility

$842.81

Effective 2026-10-01

The base rate is $33.89 higher than on 2025-10-01, moving from $808.92 to $842.81 (4.2%).

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

    $808.92changed to$842.81

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 9.15 changed to 8.92
    • Practice expense RVU 14.48 changed to 14.84
    • Malpractice RVU 1.30 changed to 1.33
    • 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

    $937.05changed to$808.92

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 17.22 changed to 14.48
    • Malpractice RVU 1.69 changed to 1.30

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $921.75changed to$937.05

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $953.63changed to$921.75

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 17.23 changed to 17.22
    • Malpractice RVU 1.65 changed to 1.69
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $949.86changed to$953.63

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

  6. January 1, 2023

    RVU23A

    $965.59changed to$949.86

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 16.96 changed to 17.23
    • Malpractice RVU 1.68 changed to 1.65
    • 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

    $962.74changed to$965.59

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 16.71 changed to 16.96
    • Malpractice RVU 1.62 changed to 1.68

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $949.31changed to$962.74

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 15.44 changed to 16.71
    • Malpractice RVU 1.61 changed to 1.62
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $824.27changed to$949.31

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 12.23 changed to 15.44
    • Malpractice RVU 1.42 changed to 1.61
    • 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

    $819.74changed to$824.27

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 12.13 changed to 12.23

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $761.62changed to$819.74

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 12.94 changed to 12.13
    • Malpractice RVU 1.55 changed to 1.42
    • 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

    $649.87changed to$761.62

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 12.21 changed to 12.94
    • Malpractice RVU 1.34 changed to 1.55
    • 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

    $677.63changed to$649.87

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 13.13 changed to 12.21
    • Malpractice RVU 1.54 changed to 1.34

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $674.26changed to$677.63

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $643.41changed to$674.26

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 12.29 changed to 13.13
    • Malpractice RVU 1.13 changed to 1.54
    • 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

    $647.71changed to$643.41

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 14.15 changed to 12.29
    • Malpractice RVU 1.18 changed to 1.13
    • 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: $647.71

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$842.81$545.99RVU26D
2026-07-01$842.81$545.99RVU26C
2026-04-01$842.81$545.99RVU26B
2026-01-01$842.81$545.99RVU26A
2025-10-01$808.92$602.73RVU25D
2025-07-01$808.92$602.73RVU25C
2025-04-01$808.92$602.73RVU25B
2025-01-01$808.92$602.73RVU25A
2024-10-01$937.05$680.95RVU24D
2024-07-01$937.05$680.95RVU24C
2024-04-01$937.05$680.95RVU24B
2024-03-09$937.05$680.95RVU24AR
2024-01-01$921.75$669.84RVU24A
2023-10-01$953.63$690.27RVU23D
2023-07-01$949.86$688.59RVU23C
2023-04-01$949.86$688.59RVU23B
2023-01-01$949.86$688.59RVU23A
2022-10-01$965.59$695.59RVU22D
2022-07-01$965.59$695.59RVU22C
2022-04-01$965.59$695.59RVU22B
2022-01-01$965.59$695.59RVU22A
2021-10-01$962.74$695.07RVU21D
2021-07-01$962.74$695.07RVU21C
2021-04-01$962.74$695.07RVU21B
2021-01-01$962.74$695.07RVU21A
2020-10-01$949.31$708.48RVU20D
2020-07-01$949.31$708.48RVU20C
2020-04-01$949.31$708.48RVU20B
2020-01-01$949.31$708.48RVU20A
2019-10-01$824.27$639.18RVU19D
2019-07-01$824.27$639.18RVU19C
2019-04-01$824.27$639.18RVU19B
2019-01-01$824.27$639.18RVU19A
2018-10-01$819.74$640.65RVU18D
2018-07-01$819.74$640.65RVU18C
2018-04-01$819.74$640.65RVU18B
2018-01-01$819.74$640.65RVU18AR1
2017-10-01$761.62$615.70RVU17D
2017-07-01$761.62$615.70RVU17C
2017-04-01$761.62$615.70RVU17B
2017-01-01$761.62$615.70RVU17A
2016-10-01$649.87$521.14RVU16D
2016-07-01$649.87$521.14RVU16C
2016-04-01$649.87$521.14RVU16B
2016-01-01$649.87$521.14RVU16A
2015-10-01$677.63$556.79RVU15D
2015-07-01$677.63$556.79RVU15C
2015-04-01$674.26$554.02RVU15B
2015-01-01$674.26$554.02RVU15A
2014-10-01$643.41$516.24RVU14D
2014-07-01$643.41$516.24RVU14C
2014-04-01$643.41$516.24RVU14B
2014-01-01$643.41$516.24RVU14A
2013-10-01$647.71$527.76RVU13D
2013-07-01$647.71$527.76RVU13C
2013-04-01$647.71$527.76RVU13B
2013-01-01$647.71$527.76RVU13AR

Price 40842 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

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
RVUs for 40842PPRRVU2026_Oct_nonQPP.csv, line 4,873 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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