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CPT 12011: Simple Repair of Superficial Facial and Mucous Membrane Wounds
CPT code 12011 represents the simple repair of superficial lacerations of the face, ears, eyelids, nose, lips, and mucous membranes measuring 2.5 cm or less. This code is widely used across outpatient, urgent care, and emergency settings for minor soft-tissue closures on cosmetically sensitive areas. Nationally, accurate use of this code affects quality reporting, encounter documentation, and appropriate payment for common wound care services.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for when 12011 applies, comparisons to closely related simple repair codes for other anatomic sites, and an overview of common billing modifiers and diagnoses typically associated with facial laceration repair.
The publication outlines benchmarks and practical billing considerations relevant to coding accuracy and claim processing, plus clarification of typical sites of service for this procedure. The content is intended to help clinicians, coding staff, and revenue cycle professionals understand the clinical scope of CPT code 12011, its proper application, and the payer landscape for this frequently billed minor surgical service.
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Billing Code Overview
CPT code 12011 describes the simple repair of superficial wounds located on the face, ears, eyelids, nose, lips, and/or mucous membranes when the repair measures 2.5 cm or less. This service is performed to close superficial lacerations and restore tissue continuity.
Service type: Simple wound repair
Typical site of service: Outpatient clinic, urgent care, emergency department, or office-based procedure on the face or adjacent mucous membranes
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.