CPT code 40843: Mouth reconstruction, extensive, with skin graft2026 Medicare rate & RVUs in Illinois
Reported for extensive mouth reconstruction using a skin graft to repair a substantial defect, with selection based on the reconstruction and graft documented.
Medicare pays $1,268.29–$1,401.55 for 40843 in the office in Illinois, from Rest of Illinois to Chicago, IL. 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 40843 covers
This service reconstructs an extensive area of the mouth using a skin graft, including obtaining the graft. Oral and maxillofacial surgeons, plastic surgeons, or otolaryngologists may perform it to repair a substantial oral defect, such as one resulting from tumor removal or significant trauma. The operative report should describe the extent of reconstruction, the defect repaired, and the graft used.
Report this code when the documented service is extensive reconstruction with a skin graft; distinguish it from reconstruction with a free mucosal graft or split-thickness skin graft. Medicare coverage is restricted to specific circumstances. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in the same session, the highest-valued procedure is paid in full and the others are subject to a 50% reduction. The code is priced as bilateral, so modifier 50 does not increase payment. An assistant at surgery may be paid; 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 40843 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
4 payment localities
$1268.29 to $1401.55
| Payment locality | Office | Facility |
|---|---|---|
| Chicago, IL | $1,401.55 | $883.26 |
| East St. Louis, IL | $1,308.84 | $834.38 |
| Rest of Illinois | $1,268.29 | $797.44 |
| Suburban Chicago, IL | $1,378.63 | $849.00 |
How the 40843 rate is calculated
Each of 40843’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 · 40843
RVUs × geographic indexes × conversion factor
Work12.47
12.47 RVUs× 1.000 GPCI
Practice expense23.96
23.96 RVUs× 1.000 GPCI
Malpractice2.32
2.32 RVUs× 1.000 GPCI
Adjusted RVUs
38.7500
Conversion factor
$33.4009
Medicare rate
$1,294.28
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 40843
40843 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 40843
Mouth reconstruction, extensive, with skin graft
| 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) | 2 | Already bilateral by definition: paid once at 100%. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| 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 · 40843
Mouth reconstruction, extensive, with skin graft
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
40843 without 51 · national office
$1,294.28
Mouth reconstruction, extensive, with skin graft
40843-51 · Second procedure: 50%
$647.14
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%).
40843 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 40840Mouth reconstructionAnterior vestibuloplasty
- 40840 is for limited mouth reconstruction. Choose 40843 for an extensive reconstruction performed with a skin graft.
- 40842Mouth reconstructionExtensive reconstruction
- 40842 describes extensive mouth reconstruction without specifying a graft type. Use 40843 when the reconstruction uses a skin graft.
- 40844Mouth reconstructionMucosal graft included
- 40844 identifies extensive reconstruction with a free mucosal graft. This code is for the skin-graft option.
- 40845Mouth reconstructionWith bone graft
- 40845 identifies extensive reconstruction with a split-thickness skin graft. Select between it and 40843 according to the graft type documented.
40843 billing questions
How is this code distinguished from 40842?
40843 is for extensive mouth reconstruction with a skin graft. 40842 describes extensive reconstruction without specifying a graft type.
When should 40844 or 40845 be considered instead?
40844 is for extensive reconstruction with a free mucosal graft, and 40845 is for extensive reconstruction with a split-thickness skin graft. Select based on the graft used and documented.
Can graft harvesting be reported separately?
No. The service includes obtaining the skin graft, so do not separately report graft acquisition.
Can modifier 50 increase payment?
No. CMS prices this code as bilateral, and modifier 50 does not increase payment.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or another surgeon be reported?
An assistant at surgery may be paid. Co-surgeons and team surgery are not permitted for this code under the CMS rules provided.
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
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