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CPT 12031: Intermediate Repair of Small Scalp/Trunk/Extremity Wounds
Headline: CPT code 12031: Intermediate wound repair for small lacerations
Lead: CPT code 12031 covers the intermediate layered repair of wounds to the scalp, axillae, trunk, and extremities (excluding hands and feet) that are 2.5 cm or less, a common procedural entry in acute care and outpatient settings.
What this code represents and why it matters: CPT code 12031 identifies a mid-level surgical repair procedure used when a wound requires layered closure techniques rather than a simple superficial suture. Nationally, accurate use of this code affects clinical documentation, procedure tracking, and payment for a high-volume service in emergency departments, urgent care centers, and ambulatory surgical practices.
Key payers covered: The analysis includes major national payers: Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare.
Overview of reader takeaways: Readers will find a clear summary of the clinical context for CPT code 12031, typical service locations, and how it relates to nearby procedural codes for simple and complex closures. The publication provides benchmarks and policy-relevant notes used by billing and compliance teams to align coding with documentation, plus comparisons to related closure codes to assist in correct code selection. Data not available in the input for payer-specific reimbursement rates and utilization trends.
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Billing Code Overview
CPT code 12031 describes the intermediate repair of wounds to the scalp, axillae, trunk, and/or extremities (excluding hands and feet) that measure 2.5 cm or less. This procedure involves layered closure techniques beyond simple superficial suturing, appropriate for wounds requiring more than a simple repair but less than complex closure.
Service type: Intermediate wound repair (layered closure) of scalp, axillae, trunk, or extremities.
Typical site of service: Emergency department, outpatient clinic, urgent care, or physician office where acute laceration management and procedural wound closure are performed.
National Reimbursement Benchmarks
Commercial averages sit well above Medicare for CPT 12031: Blue Cross Blue Shield, Cigna, UnitedHealth Group, Aetna and BUCA all have mean rates higher than Medicare’s mean of $269.6, with BUCA’s mean at $319.3 representing a moderate premium over Medicare. This positions Medicare near the lower end of national average reimbursement for this code while BUCA and other commercial payers reflect higher routine commercial pricing.
Dispersion (P75 minus P25) highlights where commercial rate variability is tightest or widest. Aetna’s interquartile range is $165.0; Blue Cross Blue Shield’s is $168.1; Cigna’s is $189.5; UnitedHealth Group’s is $226.9; and BUCA’s is $184.4. UnitedHealth Group shows the widest IQR, indicating the greatest middle-range variability, while Aetna has the tightest IQR among those listed, indicating comparatively more consistent commercial rates.