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    v1.0.30
    OpenPayerBilling CodesRepair-Simple Procedures on the Integumentary SystemCPT cpt-12011-simple-repair-superficial-facial-wound-2-5cm-or-less
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    CPT 12011: Simple Repair of Superficial Facial/Mucous Membrane Wounds ≤2.5 cm

    Medicare pays $144 and commercial payers pay $206 on average nationally for this procedure.

    CPT code 12011 describes the simple repair of superficial wounds of the face, ears, eyelids, nose, lips, and/or mucous membranes that are 2.5 cm or less; this procedure is a minor soft-tissue repair typically performed as an outpatient procedure in clinic, urgent care, emergency department, or ambulatory surgical settings and involves wound approximation with simple closure techniques such as sutures or adhesive methods.

    For related coverage guidance, see recent payer policy updates: Mohs Micrographic Surgery, Mohs Micrographic Surgery, Mohs Micrographic Surgery.

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    National Reimbursement Benchmarks

    Across national benchmarks for CPT 12011, Medicare’s mean of $144.20 sits below BUCA’s average commercial mean of $205.70, indicating BUCA pays about $61.50 more on average than Medicare for this service. Medicare’s distribution is tight around its central tendency (P25 $135, P50 $143, P75 $150), while BUCA’s interquartile spread reflects broader commercial variation (P25 $152.30, P75 $254.90).

    Comparing interquartile ranges (P75 minus P25) highlights which payers have tighter or wider rate dispersion: Blue Cross Blue Shield shows the widest IQR at $108.90 ($316.50–$208.60), followed by BUCA at $102.60, Cigna at $106.10, and UnitedHealth Group at $103.20. Aetna’s IQR is $74.90, and Medicare’s IQR is the tightest at $15.00, indicating the most concentrated central range among the listed payers.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 28-year-old patient presents to the emergency department after sustaining a 1.8 cm superficial laceration to the left upper lip from a fall. The wound involves the vermilion border but does not penetrate mucosa deeply, contains no foreign body, and there is minimal bleeding after local pressure. After triage and tetanus status confirmation, the physician performs local infiltration anesthesia, irrigates the wound, achieves hemostasis, and completes a layered simple closure with non-absorbable interrupted sutures for the skin and absorbable sutures for any small mucosal component. The procedure is billed as 12011 for a simple repair of a superficial facial wound ≤2.5 cm.

    The clinical workflow includes: initial assessment and documentation of wound size, location, contamination, and neurovascular status; wound preparation (irrigation, debridement as needed); anesthesia administration; repair and dressing; post-procedure instructions and follow-up for suture removal. The encounter is coded with an appropriate ICD-10 diagnosis such as S01.411A (laceration of lip, initial encounter). Typical providers performing this service include emergency medicine physicians, family medicine clinicians, dermatologists, and plastic surgeons. Typical sites of service are the emergency department, urgent care clinic, or ambulatory procedure suite within dermatology or plastic surgery clinics.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure

    Related Modifiers

    7 rows

    ModifierDescriptionWhen to Use
    25CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    24Modifier 24 denotes an unrelated evaluation and management (E/M) service performed by the same physician or qualified healthcare professional during a postoperative global period. Per CPT guidance,…- Use modifier 24 when you report an evaluation and management (E/M) service performed by the same physician or same-specialty group during a procedure’s postoperative global period that is unrelated…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    77Modifier 77 indicates that a previously performed procedure or service was legitimately repeated by a different physician or other qualified health care professional. The AMA’s CPT definition…- Use modifier 77 when a basic procedure or service already performed is repeated by a different physician or other qualified health care professional (for example, a second provider independently…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207ND0900X
    208800000X
    207Q00000X
    207P00000X
    207YS0012X
    207SG0203X
    133VN1005X
    247200000X

    Related Payer Policy Updates

    Specialty: Dermatology1 / 3

    10 rows

    PolicyPayerEffective Date
    Mohs Micrographic Surgerypremerabluecrossofwashington2027-02-05
    Mohs Micrographic Surgerypremerabluecrossofwashington2027-02-05
    Mohs Micrographic Surgerypremerabluecrossofwashington2027-02-05
    FilsuvezCigna2026-11-01
    Destruction of Pre-Malignant Skin LesionsAnthem2026-10-01
    Onychomycosis diagnostic testing and coverageOscar Health2026-10-01
    Treatment of Capillary Malformations (Port Wine Stains)universityofutahhealthplans2026-09-28
    AnzupgoCigna2026-09-15
    Hyperhidrosispriority_health_medicare2026-09-01
    Zevaskyn Coverage for Recessive Dystrophic Epidermolysis BullosaCigna2026-09-01

    Related Codes

    CPT-12001-SIMPLE-SUPERFICIAL-WOUND-REPAIR-25CM-OR-LESS

    CPT 12001: Simple repair of superficial wound, ≤2.5 cm

    CPT-12002-SIMPLE-REPAIR-SUPERFICIAL-WOUNDS-26-75MM

    CPT 12002: Simple Repair of Superficial Wounds 2.6–7.5 cm

    CPT-12004-SIMPLE-REPAIR-SUPERFICIAL-WOUND-7-6-12-5-CM

    CPT 12004: Simple Repair of Superficial Wounds 7.6–12.5 cm

    CPT-12005-SIMPLE-REPAIR-SUPERFICIAL-WOUND-12-6-TO-20CM

    CPT 12005: Simple Repair of Superficial Wound 12.6–20.0 cm

    CPT-12006-SIMPLE-REPAIR-SUPERFICIAL-WOUNDS-20-1-30-CM

    CPT 12006: Simple Repair of Superficial Wound 20.1–30.0 cm

    CPT-12007-SIMPLE-REPAIR-SUPERFICIAL-WOUNDS-OVER-30CM

    CPT 12007: Simple repair of superficial wound >30.0 cm

    CPT-12013-SIMPLE-REPAIR-SUPERFICIAL-WOUNDS-FACE-2-6-5-0-CM

    CPT 12013: Simple Repair of Superficial Facial Wounds, 2.6–5.0 cm

    CPT-12014-SIMPLE-REPAIR-SUPERFICIAL-WOUNDS-FACE-5-1-7-5-CM

    CPT 12014: Simple Repair of Superficial Facial Wounds 5.1–7.5 cm

    CPT-12015-SIMPLE-REPAIR-SUPERFICIAL-WOUNDS-FACE-76-125-CM

    CPT 12015: Simple Repair of Superficial Facial Wounds 7.6–12.5 cm

    CPT-12016-SIMPLE-REPAIR-SUPERFICIAL-WOUNDS-FACE-12-6-20-CM

    CPT 12016: Simple Repair of Superficial Wounds, Face 12.6–20 cm

    Showing 1–10 of 14

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    12001
    Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities; 2.5 cm or less
    Alternative code for simple superficial repairs at non-facial sites; used when wound location is outside face/ears/eyelids/nose/lips/mucous membranes.