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CPT 12004: Simple Repair of Superficial Wounds, 7.6–12.5 cm
CPT code 12004 describes the simple repair of superficial lacerations of the scalp, neck, axillae, external genitalia, trunk, and extremities (including hands and feet) when the total wound length is 7.6 to 12.5 cm. This everyday procedural code is commonly used in acute care settings and is relevant to surgical, primary care, and dermatology practices. Nationwide, accurate coding for wound repair affects clinical documentation, procedural tracking, and payer claim adjudication for common injury care.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find a concise review of the clinical scope of the code, how it aligns with related superficial repair codes for different anatomic sites and lengths, and practical items for billing workflows such as typical sites of service and common scenarios where 12004 applies. The analysis highlights comparisons to adjacent codes that cover shorter or facial repairs, clarifies the size-based distinction that drives code selection, and outlines associated diagnosis examples suitable for use with this procedure.
This publication provides clinicians, coders, and revenue cycle stakeholders with a national-level reference for the clinical context and billing implications of CPT code 12004, supporting consistent documentation and claim preparation.
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Billing Code Overview
CPT code 12004 describes the simple repair of superficial wounds of the scalp, neck, axillae, external genitalia, trunk, and/or extremities (including the hands and feet) when the total wound length measures 7.6 to 12.5 cm.
Service type: Simple wound repair (suturing) for superficial lacerations.
Typical site of service: Emergency department, urgent care clinic, ambulatory surgical center, or physician office, depending on clinical presentation and facility capabilities.
National Reimbursement Benchmarks
Medicare’s national mean of $166.8 sits below BUCA’s average commercial mean of $221.5, indicating that BUCA reimbursements for CPT 12004 are roughly $54.7 higher than Medicare on average. This gap highlights a meaningful premium in BUCA commercial payments versus Medicare for the same procedure.
Comparing dispersion using the interquartile range (P75–P25): Blue Cross Blue Shield shows the widest spread at $118.0 (P75 $337.6 minus P25 $219.8), followed by UnitedHealth Group at $121.1 (P75 $241.8 minus P25 $122.7) and Cigna at $118.2 (P75 $224.9 minus P25 $106.7). Aetna is much tighter with a range of $78.6 (P75 $119.7 minus P25 $41.0). BUCA’s IQR is $125.0 (P75 $276.7 minus P25 $164.2) and Medicare’s IQR is $18.0 (P75 $174 minus P25 $156), making Medicare the tightest and BUCA among the wider commercial distributions.