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    v1.0.30
    OpenPayerBilling CodesRepair-Intermediate Procedures on the Integumentary SystemCPT cpt-12031-intermediate-repair-wound-scalp-trunk-extremity-2-5cm
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    CPT 12031: Intermediate Repair of Wound, Scalp/Axilla/Trunk/Extremity 2.5 cm or Less

    Medicare pays $270 and commercial payers pay $319 on average nationally for this procedure.

    CPT code 12031 describes an intermediate repair procedure for wounds of the scalp, axillae, trunk, and/or extremities (excluding hands and feet) that are 2.5 cm or less in size; this service is a surgical wound closure involving layered soft tissue approximation beyond simple epidermal closure and is typically performed in outpatient surgical settings, emergency departments, or office-based procedure rooms.

    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

    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.

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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 emergency department after accidentally lacerating his right upper arm on broken glass. Examination reveals a 2.0 cm deep partial-thickness laceration to the lateral right upper arm without signs of foreign body, active arterial bleeding, or neurovascular compromise. The wound involves subcutaneous tissue requiring layered closure. The clinician selects 12031 for an intermediate repair of a wound ≤2.5 cm on the trunk or extremity (excluding hands and feet). Local anesthesia is administered, the wound is irrigated and debrided of devitalized tissue, layered closure of the deeper tissue is performed with absorbable sutures, and the skin is closed with nonabsorbable interrupted sutures. The procedure is performed in the ED procedure room and documented as an initial encounter for a laceration of the upper arm, consistent with diagnosis code S41.101A. Typical workflow elements include informed consent, wound irrigation, foreign body check, hemostasis, layered closure, wound dressing, discharge instructions, and follow-up for suture removal and wound reassessment. Payors commonly involved include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    11400-11466Excision of benign lesions requiring more than simple closure

    Related Modifiers

    9 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.,…
    57CPT® modifier -57 (“Decision for Surgery”) is appended to an Evaluation and Management (E/M) service when that encounter results in the initial decision to perform a major surgery (a procedure with a…- Use modifier 57 when an E/M service provided by the same provider (or same tax ID) on the day of or the day before a major surgical procedure (90‑day global period) results in the initial decision…
    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…
    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…
    54Modifier ‑54 (“Surgical care only”) is appended to a CPT surgical procedure when the reporting surgeon performs the intraoperative (surgical) component but does not furnish the preoperative and/or…- Use modifier -54 when the reporting surgeon provided only the intraoperative (surgical) component of a procedure and preoperative and/or postoperative management has been or will be provided by…
    55Modifier –55 indicates the billing provider furnished only postoperative management for a procedure that has a global surgical period. According to AAPC, this modifier is appended to the same CPT…- Use modifier -55 when billing the same CPT surgical code that has a 10- or 90-day global period and you, as a provider other than the original surgeon, furnished ONLY postoperative management (no…
    79Modifier 79 indicates a surgical procedure performed during the postoperative global period of a prior surgery that is unrelated to the original procedure. Per AMA/CPT and CMS guidance, it is…- Use modifier 79 when the same physician (or same‑specialty physician in the same group) performs a surgical procedure during the postoperative global period of a prior surgery and the new procedure…
    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
    207Q00000X
    207P00000X
    261QM1200X
    207U00000X
    2471C3401X
    2085R0202X
    281PC2000X

    Related ICD-10-CM Codes

    23 rows

    ICD-10-CM CodeDescription
    L03.115Cellulitis of right lower limb
    L03.116Cellulitis of left lower limb
    L98.9Disorder of the skin and subcutaneous tissue, unspecified
    S01.01XALaceration without foreign body of scalp, initial encounter
    S01.81XALaceration without foreign body of other part of head, initial encounter
    S11.81XALaceration without foreign body of other specified part of neck, initial encounter
    S21.011ALaceration without foreign body of right breast, initial encounter
    S31.101AUnspecified open wound of abdominal wall, left upper quadrant without penetration into peritoneal cavity, initial encounter
    S31.102AUnspecified open wound of abdominal wall, epigastric region without penetration into peritoneal cavity, initial encounter
    S41.101AUnspecified open wound of right upper arm, initial encounter

    Showing 1–10 of 23

    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-12032-INTERMEDIATE-WOUND-REPAIR-2-6-TO-7-5-CM

    CPT 12032: Intermediate Repair of Wound, 2.6–7.5 cm

    CPT-12034-INTERMEDIATE-WOUND-REPAIR-7-6-TO-12-5-CM-SCALP-TRUNK-EXTREMITIES

    CPT 12034: Intermediate Wound Repair, 7.6–12.5 cm, Scalp/Trunk/Extremities

    CPT-12035-INTERMEDIATE-WOUND-REPAIR-SCALP-TRUNK-EXTREMITIES-12-6-20CM

    CPT 12035: Intermediate Repair of Wounds 12.6–20 cm

    CPT-12036-INTERMEDIATE-REPAIR-WOUND-20-1-30-CM-SCALP-TRUNK-EXTREMITIES

    CPT 12036: Intermediate Repair of Wound 20.1–30 cm

    CPT-12037-INTERMEDIATE-REPAIR-WOUND-GREATER-THAN-30CM-SCALP-TRUNK-EXTREMITIES

    CPT 12037: Intermediate Repair of Wounds >30.0 cm

    CPT-12041-INTERMEDIATE-REPAIR-SUPERFICIAL-WOUND-2-5CM-OR-LESS

    CPT 12041: Intermediate Repair of Superficial Wound ≤2.5 cm

    CPT-12042-INTERMEDIATE-REPAIR-SUPERFICIAL-WOUND-NECK-HANDS-FEET-GENITALIA

    CPT 12042: Intermediate Repair of Superficial Wound 2.6–7.5 cm

    CPT-12044-INTERMEDIATE-REPAIR-SUPERFICIAL-WOUNDS-7-6-TO-12-5-CM

    CPT 12044: Intermediate Repair of Superficial Wound 7.6–12.5 cm

    CPT-12045-INTERMEDIATE-WOUND-REPAIR-NECK-HANDS-FEET-GENITALIA

    CPT 12045: Intermediate Repair of Superficial Wounds 12.6–20 cm

    CPT-12046-INTERMEDIATE-REPAIR-SUPERFICIAL-WOUND-20-1-TO-30-CM-NECK-HANDS-FEET-GENITALIA

    CPT 12046: Intermediate Repair of Superficial Wound 20.1–30.0 cm

    Showing 1–10 of 18

    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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    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    Codes in this range are used for lesion excision where defect closure may require more extensive techniques than a standard repair; may be considered when excision rather than primary repair is performed.
    13100-13153Complex repair codesUsed for complex closures involving extensive undermining, layered closure of deep structures, or scar revision; used when repair complexity exceeds the definition of intermediate closure represented by 12031.