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

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 Vermont, Medicare pays $811.13 for 40842 in the office and $520.47 when it’s performed in a hospital or facility.

$811.13Office (non-facility)
$520.47Hospital or facility
−3.2%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 Vermont
  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 Vermont 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. Vermont pays $811.13. The RVUs are the same everywhere; the geographic indexes change the dollars.

40842 in Vermont vs other payment areas
  1. Vermont · this page$811.13
  2. Los Angeles, CA · California$926.03+$114.90
  3. Washington, DC area · District of Columbia$947.37+$136.24
  4. Miami, FL · Florida$926.27+$115.14
  5. Chicago, IL · Illinois$900.12+$88.99
  6. Manhattan, NY · New York$963.43+$152.30
  7. Alaska · Alaska$999.27+$188.14

Other areas in Vermont 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 Vermont 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

105

Locality
Vermont
Physician work
1.000
Practice expense
0.990
Malpractice
0.506
Office calculation for 40842 in Vermont
ComponentRVULocality factorAdjusted
Physician work8.92× 1.0008.9200
Practice expense14.84× 0.99014.6916
Malpractice1.33× 0.5060.6730
Total RVUs24.2846
Conversion factor× 33.4009

Office rate, Vermont$811.13

Office: (8.92 × 1 + 14.84 × 0.99 + 1.33 × 0.506) × $33.4009 = $811.13

Facility: (8.92 × 1 + 6.05 × 0.99 + 1.33 × 0.506) × $33.4009 = $520.47

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, Vermont
Same family
40840Mouth reconstruction, anterior vestibuloplastyLimited reconstruction level; select based on the documented scope.$855.61
40843Mouth reconstruction, extensive, with skin graftComplicated reconstruction level; select based on documented scope and complexity.$1,248.00
Used instead
40844Mouth reconstruction, mucosal graft includedFor vestibule reconstruction using a split-thickness skin graft.$1,562.05
40845Mouth reconstruction, with bone graftFor vestibule reconstruction using a full-thickness skin graft.$1,424.07

How 40842 has changed in Vermont

40842 · Office / nonfacility

$811.13

Effective 2026-10-01

The base rate is $28.28 higher than on 2025-10-01, moving from $782.85 to $811.13 (3.6%).

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

    $782.85changed to$811.13

    • 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 0.993 changed to 0.990
    • Malpractice GPCI 0.518 changed to 0.506

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $902.92changed to$782.85

    • 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

    $888.18changed to$902.92

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $922.55changed to$888.18

    • 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 0.997 changed to 0.993
    • Malpractice GPCI 0.543 changed to 0.518

  5. January 1, 2023

    RVU23A

    $937.24changed to$922.55

    • 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 1.001 changed to 0.997
    • Malpractice GPCI 0.569 changed to 0.543

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $935.08changed to$937.24

    • 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.

  7. January 1, 2021

    RVU21A

    $925.72changed to$935.08

    • 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
    • Practice expense GPCI 1.008 changed to 1.001
    • Malpractice GPCI 0.582 changed to 0.569

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $807.58changed to$925.72

    • 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 1.015 changed to 1.008
    • Malpractice GPCI 0.595 changed to 0.582

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $803.04changed to$807.58

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

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $832.97changed to$803.04

    • 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 1.010 changed to 1.015
    • Malpractice GPCI 0.639 changed to 0.595

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $799.25changed to$832.97

    • 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 1.004 changed to 1.010
    • Malpractice GPCI 0.682 changed to 0.639

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $840.23changed to$799.25

    • 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.

  13. July 1, 2015

    RVU15C

    $836.04changed to$840.23

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $795.70changed to$836.04

    • 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 1.006 changed to 1.004
    • Malpractice GPCI 0.618 changed to 0.682

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    No ratechanged to$795.70

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: No rate

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$811.13$520.47RVU26D
2026-07-01$811.13$520.47RVU26C
2026-04-01$811.13$520.47RVU26B
2026-01-01$811.13$520.47RVU26A
2025-10-01$782.85$579.53RVU25D
2025-07-01$782.85$579.53RVU25C
2025-04-01$782.85$579.53RVU25B
2025-01-01$782.85$579.53RVU25A
2024-10-01$902.92$650.38RVU24D
2024-07-01$902.92$650.38RVU24C
2024-04-01$902.92$650.38RVU24B
2024-03-09$902.92$650.38RVU24AR
2024-01-01$888.18$639.77RVU24A
2023-10-01$922.55$662.07RVU23D
2023-07-01$922.55$662.07RVU23C
2023-04-01$922.55$662.07RVU23B
2023-01-01$922.55$662.07RVU23A
2022-10-01$937.24$669.12RVU22D
2022-07-01$937.24$669.12RVU22C
2022-04-01$937.24$669.12RVU22B
2022-01-01$937.24$669.12RVU22A
2021-10-01$935.08$669.28RVU21D
2021-07-01$935.08$669.28RVU21C
2021-04-01$935.08$669.28RVU21B
2021-01-01$935.08$669.28RVU21A
2020-10-01$925.72$684.89RVU20D
2020-07-01$925.72$684.89RVU20C
2020-04-01$925.72$684.89RVU20B
2020-01-01$925.72$684.89RVU20A
2019-10-01$807.58$621.02RVU19D
2019-07-01$807.58$621.02RVU19C
2019-04-01$807.58$621.02RVU19B
2019-01-01$807.58$621.02RVU19A
2018-10-01$803.04$622.53RVU18D
2018-07-01$803.04$622.53RVU18C
2018-04-01$803.04$622.53RVU18B
2018-01-01$803.04$622.53RVU18AR1
2017-10-01$832.97$660.80RVU17D
2017-07-01$832.97$660.80RVU17C
2017-04-01$832.97$660.80RVU17B
2017-01-01$832.97$660.80RVU17A
2016-10-01$799.25$615.92RVU16D
2016-07-01$799.25$615.92RVU16C
2016-04-01$799.25$615.92RVU16B
2016-01-01$799.25$615.92RVU16A
2015-10-01$840.23$668.14RVU15D
2015-07-01$840.23$668.14RVU15C
2015-04-01$836.04$664.81RVU15B
2015-01-01$836.04$664.81RVU15A
2014-10-01$795.70$610.83RVU14D
2014-07-01$795.70$610.83RVU14C
2014-04-01$795.70$610.83RVU14B
2014-01-01$795.70$610.83RVU14A
2013-10-01Rate data unavailableRate data unavailableRVU13D
2013-07-01Rate data unavailableRate data unavailableRVU13C
2013-04-01Rate data unavailableRate data unavailableRVU13B
2013-01-01Rate data unavailableRate data unavailableRVU13AR

Price 40842 for an earlier date of service

Where the Vermont rate applies

Vermont is a Medicare payment area, not a city. Our Census mapping connects it to 180 cities and communities in Vermont. Some span more than one payment area; confirm with the service ZIP.

  • Albany
  • Alburgh
  • Algiers
  • Arlington
  • Ascutney
  • Bakersfield
  • Barnet
  • Barre

Browse all communities in Vermont

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 VermontGPCI2026.csv, line 105 (RVU26D)

Open CMS sourceHow we calculate rates

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