Summary & Overview
CPT 12006: Simple Repair of Superficial Wounds, 20.1–30.0 cm
CPT code 12006 is a nationally recognized billing code for the simple repair of superficial wounds ranging from 20.1 cm to 30.0 cm in length, affecting areas such as the scalp, neck, axillae, external genitalia, trunk, and extremities. This code is widely used in clinical settings, particularly offices, to document and bill for surgical procedures on the integumentary system. The code is relevant for a variety of specialties, including dermatology, surgery, family medicine, general practice, and emergency medicine.
Major payers covering this procedure include Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare. The publication provides an overview of payer coverage, clinical context, and related coding benchmarks. Readers will gain insight into the procedural scope, typical clinical scenarios, and policy updates relevant to the use of CPT 12006. The summary also highlights associated modifiers and related codes, offering a comprehensive understanding of how this code fits within broader wound repair billing practices.
This article is designed for healthcare professionals, billing specialists, and policy analysts seeking clarity on the national landscape for superficial wound repair procedures. It covers essential information for accurate coding, payer expectations, and clinical documentation, ensuring readers are informed about the latest developments and standards for CPT 12006.
CPT Code Overview
CPT 12006 represents a simple repair of superficial wounds measuring 20.1 cm to 30.0 cm on the scalp, neck, axillae, external genitalia, trunk, and/or extremities (including hands and feet). This procedure is classified under surgical procedures on the integumentary system. The typical site of service for this code is the office (POS 11), where clinicians address lacerations and other superficial injuries requiring straightforward closure techniques.
Clinical & Coding Specifications
Clinical Context
A patient presents to the office with multiple superficial lacerations on the trunk and extremities, such as after a fall or minor accident. The wounds are clean, without foreign bodies, and require simple repair. The total length of all wounds repaired is between 20.1 cm and 30.0 cm. The procedure is performed by a provider in dermatology, surgery, family medicine, general practice, or emergency medicine. The clinical workflow includes assessment, cleaning, and closure of the wounds using simple techniques such as suturing, adhesive strips, or tissue adhesives. Documentation includes the location, length, and method of repair for each wound.
Coding Specifications
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Modifier
51(Multiple Procedures): Used when more than one procedure is performed during the same session. Indicates that12006is one of several procedures. -
Modifier
59(Distinct Procedural Service): Used to indicate that12006is a distinct service from other procedures performed on the same day, such as repairs at different anatomical sites.
| Taxonomy Code | Specialty |
|---|---|
207ND0900X | Dermatology |
208600000X | Surgery |
207Q00000X | Family Medicine |
208D00000X | General Practice |
207P00000X | Emergency Medicine |
These taxonomies represent the provider specialties commonly performing simple wound repairs.
Related Diagnoses
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S01.81XA: Laceration without foreign body of other part of head, initial encounter- Relevant for patients with superficial lacerations on parts of the head not specifically listed elsewhere, requiring simple repair.
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S01.111A: Laceration without foreign body of right eyelid and periocular area, initial encounter- Applies to lacerations of the right eyelid or surrounding area, suitable for simple closure.
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S01.112A: Laceration without foreign body of left eyelid and periocular area, initial encounter- Used for left eyelid or periocular lacerations, appropriate for simple repair.
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S01.311A: Laceration without foreign body of nose, initial encounter- Indicates a nasal laceration without foreign body, requiring simple closure.
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S01.411A: Laceration without foreign body of lip, initial encounter- For lacerations of the lip, initial encounter, suitable for simple repair.
Each diagnosis code represents a clinical scenario where a superficial wound is present and is managed with a simple repair as described by CPT code 12006.
Related CPT Codes
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12005: Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 12.6 cm to 20.0 cm.- Used for repairs when the total wound length is between 12.6 cm and 20.0 cm. It is an alternative to
12006for shorter total wound lengths.
- Used for repairs when the total wound length is between 12.6 cm and 20.0 cm. It is an alternative to
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12007: Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); over 30.0 cm.- Used for repairs when the total wound length exceeds 30.0 cm. It is an alternative to
12006for longer total wound lengths.
- Used for repairs when the total wound length exceeds 30.0 cm. It is an alternative to
These codes are selected based on the total length of wounds repaired. They are not typically used together, but may be used in sequence if multiple wounds of varying lengths are repaired.
National Reimbursement Benchmarks
Medicare's national mean rate for CPT code 12006 is $246.89, while the BUCA (average commercial) mean rate is slightly lower at $227.44. Among commercial payers, UnitedHealth Group has the highest mean rate at $306.44, and Aetna has the lowest at $141.32.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. Medicare shows the tightest range ($27.00), indicating more consistent rates nationally. In contrast, Cigna and UnitedHealth Group exhibit the widest dispersions ($145.00 and $170.67, respectively), reflecting greater variability in contracted rates.
The table and chart below present a detailed breakdown of national benchmarks for each payer, including mean rates and percentile values.
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