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    v1.0.30
    OpenPayerBilling CodesRepair-Simple Procedures on the Integumentary SystemCPT cpt-12013-simple-repair-superficial-wounds-face-2-6-5-0-cm
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    CPT 12013: Simple Repair of Superficial Facial Wounds, 2.6–5.0 cm

    Medicare pays $150 and commercial payers pay $211 on average nationally for this procedure.

    CPT code 12013 describes the simple repair of superficial wounds of the face, ears, eyelids, nose, lips, and/or mucous membranes when the repair length is 2.6 to 5.0 cm; this procedure is a minor surgical wound closure typically performed by surgical, dermatology, or otolaryngology clinicians in outpatient clinic, emergency department, or ambulatory surgical settings and is categorized as a simple wound repair service for acute laceration management.

    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

    Medicare's mean rate of $150.1 sits below BUCA's average commercial mean of $210.7, indicating commercial arrangements with BUCA tend to pay substantially more than the Medicare baseline for CPT 12013. The Medicare distribution is tight around its central tendency (P25 $140, P50 $149, P75 $156), reinforcing a close clustering of allowed amounts compared with the broader commercial market.

    Dispersion measured as P75 minus P25 highlights variation across payers: Blue Cross Blue Shield has the widest interquartile spread at $114.5 (P75 $326.3 minus P25 $211.8), followed by UnitedHealth Group at $108.9 and Cigna at $118.6. Aetna shows a narrower spread of $70.0, while BUCA’s interquartile range is $107.8. Medicare is the tightest with a spread of $16.

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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 male presents to the urgent care clinic after sustaining a 3.2 cm superficial laceration to the left upper lip while shaving. The wound involves only epidermis and superficial dermis without involvement of muscle, mucosa beyond the lip margin, or foreign body. Hemostasis is achieved with direct pressure; local infiltration anesthesia with 1% lidocaine with epinephrine is administered; the wound is cleansed, irrigated, and closed with interrupted 6-0 nylon sutures in a single-layer simple fashion. The clinician documents wound location, length (3.2 cm), depth (superficial), technique (simple repair), anesthesia used, time and personnel, and postoperative care instructions. The procedure is reported with 12013 for simple repair of a superficial wound 2.6 to 5.0 cm on the lip (face). Typical sites of service include urgent care centers, emergency departments, and outpatient surgical or dermatology clinics. Common workflow steps: triage and wound assessment, anesthesia/analgesia, irrigation and hemostasis, simple layered closure as indicated, dressing application, documentation of informed consent and aftercare, and scheduling follow-up for suture removal.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    12011Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or lessRepresents shorter-length simple repairs when wound measures 2.5 cm or less; used when wound length does not meet criteria.

    Related Modifiers

    8 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…
    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…
    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…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    208600000X
    207Y00000X
    207N00000X
    332S00000X
    364SX0204X
    2084S0012X
    2080P0206X
    204F00000X

    Related ICD-10-CM Codes

    19 rows

    ICD-10-CM CodeDescription
    S00.01XAAbrasion of scalp, initial encounter
    S00.12XAContusion of left eyelid and periocular area, initial encounter
    S00.83XAContusion of other part of head, initial encounter
    S01.01XALaceration without foreign body of scalp, initial encounter
    S01.111ALaceration without foreign body of right eyelid and periocular area, initial encounter
    S01.211A
    S01.21XALaceration without foreign body of nose, initial encounter
    S01.411ALaceration without foreign body of right cheek and temporomandibular area, initial encounter
    S01.81XALaceration without foreign body of other part of head, initial encounter
    S01.81XDLaceration without foreign body of other part of head, subsequent encounter

    Showing 1–10 of 19

    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-12011-SIMPLE-REPAIR-SUPERFICIAL-FACIAL-WOUND-2-5CM-OR-LESS

    CPT 12011: Simple Repair of Superficial Facial/Mucous Membrane Wounds ≤2.5 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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    12013
    12014Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 5.1 cm to 7.5 cmRepresents longer simple repairs; used when wound length exceeds the 12013 range and meets 5.1–7.5 cm criteria.