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CPT 12016: Simple Repair of Superficial Facial and Mucosal Wounds, 12.6–20.0 cm
CPT code 12016 denotes the simple repair of superficial lacerations to the face, ears, eyelids, nose, lips, and mucous membranes measuring 12.6 to 20.0 cm. This code is commonly billed in acute care settings for straightforward wound closures that do not require intermediate or complex layered techniques. Nationally, simple repair codes like 12016 are frequently encountered in emergency and outpatient procedural workflows and affect billing, clinical documentation, and payer policy around wound management.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for 12016, comparisons to related simple and intermediate repair codes, and the payer landscape relevant to coverage and coding practice. The publication also outlines typical service settings and associated ICD-10 diagnoses commonly reported with this procedure.
This summary is intended to help clinicians, coding professionals, and billing analysts quickly understand where CPT code 12016 fits within wound repair coding, what clinical scenarios prompt its use, and which major national payers are most relevant to reimbursement and policy considerations.
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Billing Code Overview
CPT code 12016 describes the simple repair of superficial wounds located on the face, ears, eyelids, nose, lips, and/or mucous membranes when the wound length is 12.6 to 20.0 cm. This procedure represents a straightforward closure technique for superficial lacerations that do not require layered or complex reconstruction.
Service type: Simple wound repair
Typical site of service: Emergency department, urgent care, or outpatient surgical/procedural clinic, reflecting the common clinical settings where acute superficial facial and mucosal lacerations are evaluated and closed.
National Reimbursement Benchmarks
National averages show Medicare at a mean of $274.70 versus BUCA (average commercial) at $333.90, placing BUCA about $59.20 higher than Medicare on average for CPT 12016. Blue Cross Blue Shield and Cigna both sit above Medicare’s mean as well, while Aetna and UnitedHealth Group have means around or slightly above Medicare; this positions Medicare near the lower-middle of the national mean spectrum but not at the absolute low.
Dispersion measured as P75 minus P25 reveals that Blue Cross Blue Shield has the widest interquartile spread at $264.00 ($510.00 − $274.60), followed by UnitedHealth Group at $183.20 ($405.00 − $206.80). Aetna’s spread is $130.70 ($174.10 − $41.40) and Cigna’s is $195.40 ($386.40 − $193.00). BUCA’s IQR is $229.30 ($429.30 − $220.00), and Medicare’s is narrow at $30.00 ($288.00 − $258.00), indicating Medicare rates are the tightest while Blue Cross Blue Shield exhibits the most variability.