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.
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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.