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See a sample rate comparisonCPT 40843 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
Surgery On Mouth Opening, Surgery To Enlarge The Opening Of The Mouth And Build Up The Bony Ridge That Holds The Gums And Teeth (Alveolar Process).
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 11 - Office 21 - Inpatient Hospital |
| Common Modifiers | 51 - Multiple procedures 59 - Distinct Procedural Service 58 - Staged or related procedure during postoperative period |
| Complexity Level | High |
| Medicare Fee Schedule | $1,294.29 national non-facility rate (2026) · View Medicare rates for 40843 |
| Medicaid Fee Schedule | $1,030.605 median of the 8 states in the free preview · View Medicaid rates for 40843 |
National average reimbursement for CPT 40843 by major payers:
$1,409.52
$1,484.44
$1,580.34
$1,830.64
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CPT 40843
5 of 25 sample ratesHigher to lower in this preview
Baycare Aurora Kaukauna Surgery Center LLC, Kaukauna Surgery Center
Baycare Aurora Kaukauna Surgery Center LLC
$7,169.00Published rateProvidence Health Services Of Waco, Providence Health Center
Ascension Providence
$2,590.00Published ratePacific Vascucare Surgery Center
$1,925.00Published rateRiverview Surgical Center LLC
Riverview Surgical Center, LLC
$1,204.00Published rateTampa Fl Endoscopy Asc LLC, Tampa Bay Endoscopy Center
Tampa Fl Endoscopy Asc LLC
$519.00Published rate
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See a sample payer proposalCPT 40843 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 40843 code is part of the Surgery services used for Surgical Procedures on the Digestive System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 40843 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 40840-CPT | High | Surgery On Mouth Opening, Surgery To Enlarge The Opening Of The Mouth And Build Up The Bony Ridge That Holds The Gums And Teeth (Alveolar Process). |
| 40842-CPT | High | Surgery On Mouth Opening, Surgery To Enlarge The Opening Of The Mouth And Build Up The Bony Ridge That Holds The Gums And Teeth (Alveolar Process). |
| 40843-CPT | High | Surgery On Mouth Opening, Surgery To Enlarge The Opening Of The Mouth And Build Up The Bony Ridge That Holds The Gums And Teeth (Alveolar Process). |
| 40844-CPT | High | Surgery On Mouth Opening, Surgery To Enlarge The Opening Of The Mouth And Build Up The Bony Ridge That Holds The Gums And Teeth (Alveolar Process). |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 40843. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 40843 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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