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CPT 13101: Complex Repair of Wound to Trunk (2.6–7.5 cm)
CPT code 13101 designates a complex surgical repair of a wound on the trunk measuring 2.6 to 7.5 cm. This code is used to distinguish more technically demanding, layered closures from simple and intermediate repairs and supports accurate clinical documentation and billing for operative wound management. Nationally, correct use of this code affects surgical quality reporting, claim adjudication, and provider reimbursement for wound care services.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines payer-specific coverage considerations, common billing modifiers, and related coding guidance to aid correct submission.
Readers will find concise benchmarks for code use relative to adjacent codes 13100 and 13102, clinical context for when a repair qualifies as complex, and mapping to common presenting diagnoses. The report also summarizes expected sites of service and typical provider specialties involved in performing this procedure. Data not available in the input are noted where applicable.
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Billing Code Overview
CPT code 13101 describes a complex repair of a wound of the trunk, with the primary wound length between 2.6 and 7.5 centimeters. This procedure involves layered closure techniques and extensive repair work beyond simple or intermediate closures.
Service Type: Surgical wound repair (complex)
Typical Site of Service: Hospital outpatient department or ambulatory surgical center, and may also be performed in an office setting when appropriate.
National Reimbursement Benchmarks
Commercial averages sit above Medicare for CPT 13101: Blue Cross Blue Shield and BUCA show notably higher means, with BUCA’s mean at $681.80 exceeding Medicare’s mean of $404.40 by $277.40, indicating commercial payers generally reimburse more than Medicare for this code. UnitedHealth Group, Cigna, Aetna and Blue Cross Blue Shield means also lie above Medicare, reinforcing a commercial/Medicare gap in national benchmarks.
Dispersion (P75 minus P25) varies substantially: Blue Cross Blue Shield is widest with a spread of $472.00 ($1,088.50 - $617.60), followed by UnitedHealth Group at $380.20 ($719.40 - $359.20). BUCA’s interquartile spread is $197.00 ($874.00 - $467.70), while Cigna’s is $363.70 ($671.50 - $330.80). Aetna is the tightest among listed payers with a spread of $236.20 ($372.90 - $113.70). These differences highlight where negotiated rates are most variable versus relatively concentrated.