CPT code 40845: Mouth reconstruction, with bone graft2026 Medicare rate & RVUs
Reports floor-of-mouth reconstruction using a bone graft when the documented procedure and clinical circumstances support this reconstructive service.
Medicare pays $1,476.99 for 40845 nationally in the office and $1,049.12 in a hospital or facility. Local office rates run $1,326.05–$1,837.24.
Medicare rate · 40845
Mouth reconstruction, with bone graft
- Work RVUs
- 18.88
- Total RVUs
- 44.22
- Global days
- 090
National rate · 2026
$1,476.99
Office setting, before claim adjustments.
See every locality for 40845 →Billed by an NP, PA or therapist? →
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 10 sections
What 40845 covers
This service reconstructs the floor of the mouth using a bone graft. Oral and maxillofacial surgeons and other surgeons qualified in oral reconstruction typically perform it in a hospital operating room or outpatient surgical setting. The operative report should identify the site, reconstructive work, and bone graft used, rather than describing only lesion removal or closure of an acute wound.
Select 40845 when the reconstruction uses a bone graft; codes 40840–40844 distinguish other approaches by the extent of reconstruction and whether a skin graft is used. Medicare coverage is restricted to specific circumstances, so documentation should support the indication and work performed. The 90-day global period includes the day-before preoperative visit and related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and others are subject to the standard 50% reduction. Modifier 50 is inappropriate. An assistant at surgery 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 40845 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$1326.05 to $1837.24
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $1,342.81 | $968.43 |
| Alaska | $1,800.09 | $1,344.42 |
| Arizona | $1,440.37 | $1,025.77 |
| Arkansas | $1,326.05 | $958.51 |
| Atlanta, GA | $1,509.41 | $1,074.70 |
| Austin, TX | $1,511.54 | $1,058.86 |
| Bakersfield, CA | $1,525.49 | $1,056.55 |
| Baltimore area, MD | $1,563.93 | $1,104.83 |
| Beaumont, TX | $1,402.56 | $1,013.20 |
| Brazoria, TX | $1,455.03 | $1,031.02 |
| Chicago, IL | $1,604.12 | $1,174.12 |
| Chico, CA | $1,517.52 | $1,048.58 |
| Colorado | $1,512.73 | $1,057.48 |
| Connecticut | $1,566.99 | $1,106.18 |
| Dallas, TX | $1,466.60 | $1,040.45 |
| Delaware | $1,461.81 | $1,039.08 |
| Detroit, MI | $1,513.59 | $1,100.70 |
| East St. Louis, IL | $1,509.76 | $1,116.13 |
| El Centro, CA | $1,517.98 | $1,049.04 |
| Fort Lauderdale, FL | $1,561.01 | $1,127.59 |
| Fort Worth, TX | $1,460.25 | $1,038.38 |
| Fresno, CA | $1,517.52 | $1,048.58 |
| Galveston, TX | $1,460.95 | $1,036.08 |
| Hanford, CA | $1,517.52 | $1,048.58 |
| Hawaii, Guam, HI | $1,541.69 | $1,055.20 |
| Houston, TX | $1,511.29 | $1,086.42 |
| Idaho | $1,368.22 | $974.58 |
| Indiana | $1,374.70 | $978.06 |
| Iowa | $1,357.47 | $965.97 |
| Kansas | $1,358.99 | $972.20 |
| Kentucky | $1,385.43 | $1,005.06 |
| King County, WA | $1,662.99 | $1,138.00 |
| Los Angeles, CA | $1,610.06 | $1,103.89 |
| Madera, CA | $1,517.52 | $1,048.58 |
| Manhattan, NY | $1,693.41 | $1,196.23 |
| Marin County, CA | $1,796.56 | $1,193.27 |
| Merced, CA | $1,517.52 | $1,048.58 |
| Metropolitan Boston, MA | $1,639.12 | $1,128.25 |
| Metropolitan Kansas City, MO | $1,428.85 | $1,027.08 |
| Metropolitan Philadelphia, PA | $1,537.00 | $1,091.59 |
| Metropolitan St. Louis, MO | $1,440.95 | $1,033.63 |
| Miami, FL | $1,648.37 | $1,202.96 |
| Minnesota | $1,434.20 | $993.93 |
| Mississippi | $1,348.14 | $979.74 |
| Modesto, CA | $1,517.52 | $1,048.58 |
| Montana | $1,476.80 | $1,048.94 |
| Napa, CA | $1,711.46 | $1,147.54 |
| Nebraska | $1,361.76 | $966.84 |
| Nevada | $1,462.40 | $1,034.11 |
| New Hampshire | $1,496.44 | $1,051.03 |
| New Mexico | $1,432.82 | $1,040.47 |
| New Orleans, LA | $1,444.96 | $1,042.34 |
| North Carolina | $1,393.28 | $994.08 |
| North Dakota | $1,422.43 | $994.56 |
| Northern New Jersey | $1,643.69 | $1,147.36 |
| NYC suburbs and Long Island, NY | $1,738.67 | $1,229.94 |
| Ohio | $1,412.08 | $1,021.44 |
| Oklahoma | $1,375.77 | $993.69 |
| Oxnard, CA | $1,597.34 | $1,091.60 |
| Portland, OR | $1,547.32 | $1,071.96 |
| Poughkeepsie and northern NYC suburbs, NY | $1,596.33 | $1,127.82 |
| Puerto Rico | $1,483.91 | $1,051.34 |
| Queens, NY | $1,695.27 | $1,189.53 |
| Redding, CA | $1,517.52 | $1,048.58 |
| Rest of California | $1,517.52 | $1,048.58 |
| Rest of Florida | $1,489.99 | $1,080.95 |
| Rest of Georgia | $1,413.13 | $1,031.48 |
| Rest of Illinois | $1,463.06 | $1,072.42 |
| Rest of Louisiana | $1,386.36 | $1,007.70 |
| Rest of Maine | $1,381.91 | $988.27 |
| Rest of Maryland | $1,484.82 | $1,051.82 |
| Rest of Massachusetts | $1,508.42 | $1,057.88 |
| Rest of Michigan | $1,423.19 | $1,032.55 |
| Rest of Missouri | $1,370.47 | $1,001.65 |
| Rest of New Jersey | $1,580.54 | $1,113.31 |
| Rest of New York | $1,411.98 | $1,005.51 |
| Rest of Oregon | $1,446.69 | $1,020.54 |
| Rest of Pennsylvania | $1,410.06 | $1,017.28 |
| Rest of Texas | $1,429.60 | $1,023.55 |
| Rest of Washington | $1,503.22 | $1,052.68 |
| Rhode Island | $1,503.95 | $1,061.96 |
| Riverside, CA | $1,547.27 | $1,078.33 |
| Sacramento, CA | $1,580.06 | $1,082.45 |
| Salinas, CA | $1,573.89 | $1,077.99 |
| San Benito County, CA | $1,837.24 | $1,220.25 |
| San Diego, CA | $1,601.72 | $1,090.00 |
| San Francisco, CA | $1,793.44 | $1,190.15 |
| San Luis Obispo, CA | $1,549.97 | $1,062.63 |
| Santa Clara County, CA | $1,824.47 | $1,207.49 |
| Santa Cruz, CA | $1,609.83 | $1,089.98 |
| Santa Maria, CA | $1,577.28 | $1,078.39 |
| Santa Rosa, CA | $1,625.32 | $1,099.90 |
| South Carolina | $1,405.87 | $1,010.52 |
| South Dakota | $1,416.00 | $988.13 |
| Southern Maine, ME | $1,436.30 | $1,012.29 |
| Stockton, CA | $1,517.52 | $1,048.58 |
| Suburban Chicago, IL | $1,572.68 | $1,133.27 |
| Tennessee | $1,365.80 | $976.87 |
| Utah | $1,422.35 | $1,020.15 |
| Vallejo, CA | $1,706.96 | $1,143.04 |
| Vermont | $1,424.07 | $1,000.48 |
| Virgin Islands, VI | $1,483.91 | $1,051.34 |
| Virginia | $1,437.16 | $1,016.56 |
| Visalia, CA | $1,517.52 | $1,048.58 |
| Washington, DC area | $1,655.73 | $1,151.70 |
| West Virginia | $1,417.73 | $1,045.92 |
| Wisconsin | $1,381.74 | $971.84 |
| Wyoming | $1,453.11 | $1,025.24 |
| Yuba City, CA | $1,517.52 | $1,048.58 |
40845 rates by state
Office rate range in each state. Select a state to see its payment localities.
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.
$1,326.05
$1,800.09
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $1,800.09 | 1 |
| AL | $1,342.81 | 1 |
| AR | $1,326.05 | 1 |
| AZ | $1,440.37 | 1 |
| CA | $1,517.52–$1,837.24 | 29 |
| CO | $1,512.73 | 1 |
| CT | $1,566.99 | 1 |
| DC | $1,655.73 | 1 |
| DE | $1,461.81 | 1 |
| FL | $1,489.99–$1,648.37 | 3 |
| GA | $1,413.13–$1,509.41 | 2 |
| GU | $1,541.69 | 1 |
| HI | $1,541.69 | 1 |
| IA | $1,357.47 | 1 |
| ID | $1,368.22 | 1 |
| IL | $1,463.06–$1,604.12 | 4 |
| IN | $1,374.70 | 1 |
| KS | $1,358.99 | 1 |
| KY | $1,385.43 | 1 |
| LA | $1,386.36–$1,444.96 | 2 |
| MA | $1,508.42–$1,639.12 | 2 |
| MD | $1,484.82–$1,655.73 | 3 |
| ME | $1,381.91–$1,436.30 | 2 |
| MI | $1,423.19–$1,513.59 | 2 |
| MN | $1,434.20 | 1 |
| MO | $1,370.47–$1,440.95 | 3 |
| MS | $1,348.14 | 1 |
| MT | $1,476.80 | 1 |
| NC | $1,393.28 | 1 |
| ND | $1,422.43 | 1 |
| NE | $1,361.76 | 1 |
| NH | $1,496.44 | 1 |
| NJ | $1,580.54–$1,643.69 | 2 |
| NM | $1,432.82 | 1 |
| NV | $1,462.40 | 1 |
| NY | $1,411.98–$1,738.67 | 5 |
| OH | $1,412.08 | 1 |
| OK | $1,375.77 | 1 |
| OR | $1,446.69–$1,547.32 | 2 |
| PA | $1,410.06–$1,537.00 | 2 |
| PR | $1,483.91 | 1 |
| RI | $1,503.95 | 1 |
| SC | $1,405.87 | 1 |
| SD | $1,416.00 | 1 |
| TN | $1,365.80 | 1 |
| TX | $1,402.56–$1,511.54 | 8 |
| UT | $1,422.35 | 1 |
| VA | $1,437.16–$1,655.73 | 2 |
| VI | $1,483.91 | 1 |
| VT | $1,424.07 | 1 |
| WA | $1,503.22–$1,662.99 | 2 |
| WI | $1,381.74 | 1 |
| WV | $1,417.73 | 1 |
| WY | $1,453.11 | 1 |
How the 40845 rate is calculated
Each of 40845’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 · 40845
RVUs × geographic indexes × conversion factor
Work18.88
18.88 RVUs× 1.000 GPCI
Practice expense22.59
22.59 RVUs× 1.000 GPCI
Malpractice2.75
2.75 RVUs× 1.000 GPCI
Adjusted RVUs
44.2200
Conversion factor
$33.4009
Medicare rate
$1,476.99
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 40845
40845 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 40845
Mouth reconstruction, with bone 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) | 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 · 40845
Mouth reconstruction, with bone 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
40845 without 51 · national office
$1,476.99
Mouth reconstruction, with bone graft
40845-51 · Second procedure: 50%
$738.50
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%).
40845 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 40840Mouth reconstructionAnterior vestibuloplasty
- 40840 describes limited floor-of-mouth reconstruction without a graft. Use 40845 when a bone graft is used for reconstruction.
- 40842Mouth reconstructionExtensive reconstruction
- 40842 describes limited reconstruction with a split-thickness skin graft. Choose 40845 when the reconstruction uses a bone graft.
- 40844Mouth reconstructionMucosal graft included
- 40844 describes extensive reconstruction with a split-thickness skin graft. Choose 40845 when the documented reconstructive method uses a bone graft.
40845 billing questions
How does 40845 differ from 40840–40844?
40845 is for floor-of-mouth reconstruction using a bone graft. The other codes distinguish reconstruction extent and whether a skin graft is used; select the code that matches the documented technique.
Can this code be used for excision of a mouth lesion?
No. Lesion removal alone is not reconstruction with a bone graft. Report the code that describes the documented lesion excision when that is the service performed.
What documentation supports reporting 40845?
The operative report should identify the floor-of-mouth site, reconstructive work, and bone graft. It should also support the clinical indication.
Can modifier 50 be reported?
No. The descriptor and anatomy make modifier 50 inappropriate for this service.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full; other procedures are subject to the standard 50% multiple-procedure reduction.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.
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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