CPT code 12004: Simple wound repair, nonfacial sites, 7.6–12.5 cm2026 Medicare rate & RVUs

Medicare pays $161.99 for 12004 nationally in the office and $72.15 in a hospital or facility. Local office rates run $141.95–$208.08.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 12004 covers

This code covers closure of a superficial wound without layered repair of deeper tissue. The site group includes the scalp, neck, axillae, external genitalia, trunk, and extremities; wounds of the face have a separate code series. A clinician typically cleans and prepares the wound, uses local anesthesia as needed, and closes the skin with sutures, staples, or tissue adhesive. These repairs commonly occur in emergency departments, urgent care, and office settings, performed by emergency, primary care, or surgical clinicians.

Select the code by the eligible site group and the combined length of simple repairs in that group, not by the number of wounds or closure materials. Document each wound’s site, length, depth, and repair method. The 0-day global period includes same-day preoperative and postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate for this code; assistant-at-surgery services are not paid, and co-surgeon and team-surgery billing are not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 12004 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

12004 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 12004 rate is calculated

Each of 12004’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 12004

The CMS indicators that decide how 12004 is paid alongside other services.

What modifiers do to the payment

When to use modifier 51

12004 compared with similar codes

How to choose

12002Wound repairSimple, 2.6–7.5 cm

Both codes cover simple repairs in the same site group; 12002 applies to a shorter combined length, while this code covers 7.6–12.5 cm.

12005Simple wound repair12.6–20.0 cm

Both codes cover simple repairs in the same site group; 12005 applies when the combined length exceeds this code’s range.

12015Simple wound repairFace and related sites, 7.6-12.5 cm

This code is for the scalp, neck, axillae, external genitalia, trunk, and extremities. Code 12015 is for the separate facial, ear, eyelid, nose, lip, and mucosal site group.

12034Wound repairIntermediate, 7.6–12.5 cm

Both codes represent repairs in a similar length range, but 12034 is for intermediate repair, which involves layered closure or repair of deeper tissue.

Codes related to 12004

Related codes aren’t interchangeable: bill the code that matches the service performed.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates