Find policies, billing codes, payers, states, and providers
CPT 12005: Simple Repair of Superficial Wound 12.6–20.0 cm
CPT code 12005 denotes the simple repair of superficial lacerations measuring 12.6 to 20.0 cm across commonly treated anatomic sites such as the scalp, neck, axillae, external genitalia, trunk, and extremities (including hands and feet). This code is part of the set of simple repair CPT codes that stratify reimbursement by wound length and anatomic complexity and is frequently used in acute care settings for straightforward closures without deep tissue involvement. Nationally, proper use of CPT code 12005 supports accurate claims processing and clinical documentation for wound management services delivered in ambulatory clinics, urgent care centers, emergency departments, and outpatient surgical suites.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will gain a concise benchmark and coding context for when to report CPT code 12005 versus adjacent length-based simple repair codes, understand common clinical settings for use, and see the typical coding neighbors for wound repairs of smaller and larger lengths. The publication highlights clinical scope, typical sites of service, and related length-based CPT distinctions to aid coding accuracy, billing alignment, and administrative clarity for national audiences.
Customize your policy alerts
Sign up for cpt 12005 policy alerts
Get alerted when payer policies referencing 12005 are released or updated.
Monitor payer policy activity
Billing Code Overview
CPT code 12005 describes the simple repair of superficial wounds measuring 12.6 to 20.0 cm. The procedure is used for uncomplicated laceration closures involving the scalp, neck, axillae, external genitalia, trunk, and extremities (including hands and feet).
Service Type: Simple wound repair
Typical Site of Service: Ambulatory clinic, urgent care, emergency department, or outpatient surgical suite, depending on clinical setting and patient needs.
National Reimbursement Benchmarks
Across national benchmarks for CPT 12005, Medicare’s mean of $217.10 sits below BUCA’s average commercial mean of $293.60, indicating that BUCA reimbursements are about $76.50 higher on average than Medicare. Blue Cross Blue Shield’s mean of $368.60 and Aetna’s mean of $100.10 further illustrate a wide commercial spread, with UnitedHealth Group ($249.40) and Cigna ($231.60) clustering between Medicare and higher commercial payers.
Dispersion measured as the interquartile range (P75 minus P25) is tightest for Aetna at $107.00 and Medicare at $23.00, reflecting relatively concentrated middle fifty percent values. The widest dispersion appears for Blue Cross Blue Shield at $214.30 and BUCA at $180.50, with UnitedHealth Group ($153.80) and Cigna ($147.10) also showing substantial variability across their commercial rates.