CPT code 12004: Simple wound repair, nonfacial sites, 7.6–12.5 cm2026 Medicare rate & RVUs in Missouri
Reports simple closure of a superficial wound at specified nonfacial sites when the combined repaired length is 7.6 to 12.5 cm.
Medicare pays $147.33–$157.01 for 12004 in the office in Missouri, from Rest of Missouri to Metropolitan St. Louis, MO. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
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 in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$147.33 to $157.01
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | $155.38 | $71.02 |
| Metropolitan St. Louis, MO | $157.01 | $71.48 |
| Rest of Missouri | $147.33 | $69.88 |
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.
How the rate is built · 12004
RVUs × geographic indexes × conversion factor
Work1.40
1.40 RVUs× 1.000 GPCI
Practice expense3.12
3.12 RVUs× 1.000 GPCI
Malpractice0.33
0.33 RVUs× 1.000 GPCI
Adjusted RVUs
4.8500
Conversion factor
$33.4009
Medicare rate
$161.99
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 12004
The CMS indicators that decide how 12004 is paid alongside other services.
CMS payment indicators · 12004
Simple wound repair, nonfacial sites, 7.6–12.5 cm
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
12004 without 51 · national office
$161.99
Simple wound repair, nonfacial sites, 7.6–12.5 cm
12004-51 · Second procedure: 50%
$81.00
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
12004 compared with similar codes
Compare codes · National
5 codes, side by side
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.
12004 billing questions
How is the length selected when there are multiple wounds?
Add the lengths of simple repairs in the same anatomical grouping and select the applicable length range. Keep documentation of each wound’s location and length.
When should 12002 or 12005 be reported instead?
Use 12002 for a shorter combined repair length in this site group and 12005 for a longer one. The site group and simple-repair method remain the same.
Can this code be used for a layered closure?
No. This code describes simple closure; a repair requiring layered closure may fit an intermediate-repair code when its site and length criteria are met.
Is local anesthesia separately reported?
Local anesthesia used for the wound closure is part of the repair service, rather than a separate service under this code.
How does Medicare handle another procedure performed in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction. The 0-day global period includes same-day preoperative and postoperative care.
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
Show the CMS file lines behind this rate
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