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

Reports simple closure of a superficial wound at specified nonfacial sites when the combined repaired length is 7.6 to 12.5 cm.

CMS RVU26DEffective Oct 1, 2026One payment locality19.9K Medicare services in 2024

In Queens, NY, Medicare pays $188.83 for 12004 in the office and $82.62 when it’s performed in a hospital or facility.

$188.83Office (non-facility)
$82.62Hospital or facility
+16.6%vs the national office rate ($161.99)

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.

We’ll open 12004 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Queens, NY
  2. What 12004 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

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 Queens, NY 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. Queens, NY pays $188.83. The RVUs are the same everywhere; the geographic indexes change the dollars.

12004 in Queens, NY vs other payment areas
  1. Queens, NY · this page$188.83
  2. Manhattan, NY · New York$188.33−$0.50
  3. NYC suburbs and Long Island, NY · New York$194.13+$5.30
  4. Poughkeepsie and northern NYC suburbs, NY · New York$176.31−$12.52
  5. Rest of New York · New York$153.51−$35.32
  6. Los Angeles, CA · California$179.28−$9.55
  7. Washington, DC area · District of Columbia$184.31−$4.52

Other areas in New York first, then benchmark localities. Bars start at $0.

Every other payment area

12004 in every other Medicare payment locality
Payment localityOfficeFacility
Miami, FLFlorida$183.12$89.59
Chicago, ILIllinois$177.12$86.82
AlaskaAlaska$187.20$91.51
AlabamaAlabama$144.18$65.57
ArkansasArkansas$141.95$64.78
ArizonaArizona$157.18$70.11
Bakersfield, CACalifornia$168.58$70.10
Chico, CACalifornia$167.68$69.21

12004 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$141.95

$187.88

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
12004 office rate range by state
State / territoryOffice rate rangeLocalities
AK$187.201
AL$144.181
AR$141.951
AZ$157.181
CA$167.68–$208.0829
CO$166.811
CT$173.271
DC$184.311
DE$159.861
FL$162.95–$183.123
GA$152.86–$166.022
GU$171.631
HI$171.631
IA$146.491
ID$147.851
IL$159.13–$177.124
IN$148.721
KS$146.521
KY$149.491
LA$149.55–$157.342
MA$166.03–$182.922
MD$162.81–$184.313
ME$149.49–$156.992
MI$154.35–$165.912
MN$157.261
MO$147.33–$157.013
MS$144.631
MT$161.971
NC$151.031
ND$155.451
NE$147.111
NH$164.891
NJ$174.52–$182.362
NM$155.561
NV$160.261
NY$153.51–$194.135
OH$153.021
OK$148.391
OR$158.30–$171.492
PA$152.84–$169.242
PR$162.981
RI$165.131
SC$152.421
SD$154.681
TN$147.411
TX$151.83–$166.888
UT$154.621
VA$156.98–$184.312
VI$162.981
VT$155.511
WA$165.49–$185.972
WI$149.991
WV$153.091
WY$159.131

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.

How the rate is built · 12004

RVUs × geographic indexes × conversion factor

Office or facility?

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.

The exact Queens, NY inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

1,398

Code
12004
Physician work
1.40
Practice expense
3.12
Malpractice
0.33

GPCI2026.csv

81

Locality
Queens, NY
Physician work
1.064
Practice expense
1.182
Malpractice
1.442
Office calculation for 12004 in Queens, NY
ComponentRVULocality factorAdjusted
Physician work1.40× 1.0641.4896
Practice expense3.12× 1.1823.6878
Malpractice0.33× 1.4420.4759
Total RVUs5.6533
Conversion factor× 33.4009

Office rate, Queens, NY$188.83

Office: (1.4 × 1.064 + 3.12 × 1.182 + 0.33 × 1.442) × $33.4009 = $188.83

Facility: (1.4 × 1.064 + 0.43 × 1.182 + 0.33 × 1.442) × $33.4009 = $82.62

Open 12004 in the RVU calculator

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

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician 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%).

When to use modifier 51

Codes related to 12004

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

Codes related to 12004
CodeHow it relatesOffice range, Queens, NY
Same family
12001Simple wound repair, 2.5 cm or lessSimple repair in the same site group for a shorter combined length.$132.96
12002Wound repair, simple, 2.6–7.5 cmSimple repair in the same site group for a shorter combined length.$162.34
12005Simple wound repair, 12.6–20.0 cmSimple repair in the same site group for a longer combined length.$245.68
Used instead
12015Simple wound repair, face and related sites, 7.6-12.5 cmSimple repair for the facial, ear, eyelid, nose, lip, or mucosal site group.$245.33
12031Wound repair, scalp, trunk, or extremityIntermediate repair for a shorter wound length in a related site group.$301.47
12034Wound repair, intermediate, 7.6–12.5 cmIntermediate repair for a similar length range in a related site group.$387.55

How 12004 has changed in Queens, NY

12004 · Office / nonfacility

$188.83

Effective 2026-10-01

The base rate is $38.24 higher than on 2025-10-01, moving from $150.59 to $188.83 (25.4%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $150.59changed to$188.83

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.44 changed to 1.40
    • Practice expense RVU 2.27 changed to 3.12
    • Malpractice RVU 0.28 changed to 0.33
    • Work GPCI 1.065 changed to 1.064
    • Practice expense GPCI 1.195 changed to 1.182
    • Malpractice GPCI 1.462 changed to 1.442

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $155.86changed to$150.59

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 2.28 changed to 2.27
    • Malpractice RVU 0.29 changed to 0.28

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $153.31changed to$155.86

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $163.45changed to$153.31

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 2.26 changed to 2.28
    • Malpractice RVU 0.27 changed to 0.29
    • Work GPCI 1.061 changed to 1.065
    • Practice expense GPCI 1.212 changed to 1.195
    • Malpractice GPCI 2.061 changed to 1.462

  5. January 1, 2023

    RVU23A

    $170.98changed to$163.45

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 2.20 changed to 2.26
    • Work GPCI 1.056 changed to 1.061
    • Practice expense GPCI 1.228 changed to 1.212
    • Malpractice GPCI 2.661 changed to 2.061

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $170.61changed to$170.98

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 2.18 changed to 2.20
    • Malpractice RVU 0.26 changed to 0.27

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $164.82changed to$170.61

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 1.98 changed to 2.18
    • Malpractice RVU 0.27 changed to 0.26
    • Work GPCI 1.054 changed to 1.056
    • Practice expense GPCI 1.214 changed to 1.228
    • Malpractice GPCI 2.391 changed to 2.661

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $154.75changed to$164.82

    • Conversion factor 36.0391 changed to 36.0896
    • Malpractice RVU 0.19 changed to 0.27
    • Work GPCI 1.052 changed to 1.054
    • Practice expense GPCI 1.200 changed to 1.214
    • Malpractice GPCI 2.121 changed to 2.391

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $157.60changed to$154.75

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 2.05 changed to 1.98

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $155.08changed to$157.60

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 1.98 changed to 2.05
    • Malpractice RVU 0.20 changed to 0.19
    • Malpractice GPCI 2.151 changed to 2.121

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $154.86changed to$155.08

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense GPCI 1.199 changed to 1.200
    • Malpractice GPCI 2.181 changed to 2.151

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $156.63changed to$154.86

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 1.99 changed to 1.98
    • Malpractice RVU 0.21 changed to 0.20

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $155.85changed to$156.63

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $152.84changed to$155.85

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 1.94 changed to 1.99
    • Malpractice RVU 0.23 changed to 0.21
    • Work GPCI 1.057 changed to 1.052
    • Practice expense GPCI 1.197 changed to 1.199
    • Malpractice GPCI 1.836 changed to 2.181

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $152.84changed to$152.84

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 2.18 changed to 1.94
    • Malpractice RVU 0.24 changed to 0.23
    • Work GPCI 1.062 changed to 1.057
    • Practice expense GPCI 1.195 changed to 1.197
    • Malpractice GPCI 1.491 changed to 1.836

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $152.84

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$188.83$82.62RVU26D
2026-07-01$188.83$82.62RVU26C
2026-04-01$188.83$82.62RVU26B
2026-01-01$188.83$82.62RVU26A
2025-10-01$150.59$81.02RVU25D
2025-07-01$150.59$81.02RVU25C
2025-04-01$150.59$81.02RVU25B
2025-01-01$150.59$81.02RVU25A
2024-10-01$155.86$83.86RVU24D
2024-07-01$155.86$83.86RVU24C
2024-04-01$155.86$83.86RVU24B
2024-03-09$155.86$83.86RVU24AR
2024-01-01$153.31$82.49RVU24A
2023-10-01$163.45$89.52RVU23D
2023-07-01$163.45$89.52RVU23C
2023-04-01$163.45$89.52RVU23B
2023-01-01$163.45$89.52RVU23A
2022-10-01$170.98$96.19RVU22D
2022-07-01$170.98$96.19RVU22C
2022-04-01$170.98$96.19RVU22B
2022-01-01$170.98$96.19RVU22A
2021-10-01$170.61$96.05RVU21D
2021-07-01$170.61$96.05RVU21C
2021-04-01$170.61$96.05RVU21B
2021-01-01$170.61$96.05RVU21A
2020-10-01$164.82$97.35RVU20D
2020-07-01$164.82$97.35RVU20C
2020-04-01$164.82$97.35RVU20B
2020-01-01$164.82$97.35RVU20A
2019-10-01$154.75$89.01RVU19D
2019-07-01$154.75$89.01RVU19C
2019-04-01$154.75$89.01RVU19B
2019-01-01$154.75$89.01RVU19A
2018-10-01$157.60$88.91RVU18D
2018-07-01$157.60$88.91RVU18C
2018-04-01$157.60$88.91RVU18B
2018-01-01$157.60$88.91RVU18AR1
2017-10-01$155.08$89.62RVU17D
2017-07-01$155.08$89.62RVU17C
2017-04-01$155.08$89.62RVU17B
2017-01-01$155.08$89.62RVU17A
2016-10-01$154.86$89.18RVU16D
2016-07-01$154.86$89.18RVU16C
2016-04-01$154.86$89.18RVU16B
2016-01-01$154.86$89.18RVU16A
2015-10-01$156.63$90.28RVU15D
2015-07-01$156.63$90.28RVU15C
2015-04-01$155.85$89.83RVU15B
2015-01-01$155.85$89.83RVU15A
2014-10-01$152.84$88.95RVU14D
2014-07-01$152.84$88.95RVU14C
2014-04-01$152.84$88.95RVU14B
2014-01-01$152.84$88.95RVU14A
2013-10-01$152.84$84.53RVU13D
2013-07-01$152.84$84.53RVU13C
2013-04-01$152.84$84.53RVU13B
2013-01-01$152.84$84.53RVU13AR

Price 12004 for an earlier date of service

Where the Queens, NY rate applies

Queens, NY is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in New York. Some span more than one payment area; confirm with the service ZIP.

Browse all communities in New York

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
RVUs for 12004PPRRVU2026_Oct_nonQPP.csv, line 1,398 (RVU26D)
Geographic factors for Queens, NYGPCI2026.csv, line 81 (RVU26D)

Open CMS sourceHow we calculate rates

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