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

In Miami, FL, Medicare pays $183.12 for 12004 in the office and $89.59 when it’s performed in a hospital or facility.

Check a contract rate as a % of Medicare · 12004 nationwide

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.

How Miami, FL compares for 12004

Across 109 of 109 payment localities, the office rate for 12004 runs from $141.95 in Arkansas to $208.08 in San Benito County, CA. Miami, FL pays $183.12. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

12004 rates by state

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

See 12004 in every payment locality

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

Codes related to 12004

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

How 12004 has changed in Miami, FL

Price 12004 for an earlier date of service

Where the Miami, FL rate applies

Miami, FL is a Medicare payment area, not a city. Our Census mapping connects it to 83 cities and communities in Florida. Some span more than one payment area; confirm with the service ZIP.

• Miami
• Aventura
• Bal Harbour
• Bay Harbor Islands
• Big Coppitt Key
• Big Pine Key
• Biscayne Gardens
• Biscayne Park

Browse all communities in Florida

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