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

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 Puerto Rico, Medicare pays $162.98 for 12004 in the office and $72.14 when it’s performed in a hospital or facility.

$162.98Office (non-facility)
$72.14Hospital or facility
+0.6%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 Puerto Rico
  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 Puerto Rico 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. Puerto Rico pays $162.98. The RVUs are the same everywhere; the geographic indexes change the dollars.

12004 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$162.98
  2. Los Angeles, CA · California$179.28+$16.30
  3. Washington, DC area · District of Columbia$184.31+$21.33
  4. Miami, FL · Florida$183.12+$20.14
  5. Chicago, IL · Illinois$177.12+$14.14
  6. Manhattan, NY · New York$188.33+$25.35
  7. Alaska · Alaska$187.20+$24.22

Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.

Every other payment area

12004 in every other Medicare payment locality
Payment localityOfficeFacility
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
El Centro, CACalifornia$167.73$69.26
Fresno, CACalifornia$167.68$69.21
Hanford, 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 Puerto Rico 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

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 12004 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work1.40× 1.0001.4000
Practice expense3.12× 1.0113.1543
Malpractice0.33× 0.9850.3251
Total RVUs4.8794
Conversion factor× 33.4009

Office rate, Puerto Rico$162.98

Office: (1.4 × 1 + 3.12 × 1.011 + 0.33 × 0.985) × $33.4009 = $162.98

Facility: (1.4 × 1 + 0.43 × 1.011 + 0.33 × 0.985) × $33.4009 = $72.14

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, Puerto Rico
Same family
12001Simple wound repair, 2.5 cm or lessSimple repair in the same site group for a shorter combined length.$114.69
12002Wound repair, simple, 2.6–7.5 cmSimple repair in the same site group for a shorter combined length.$140.20
12005Simple wound repair, 12.6–20.0 cmSimple repair in the same site group for a longer combined length.$212.34
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.$211.99
12031Wound repair, scalp, trunk, or extremityIntermediate repair for a shorter wound length in a related site group.$261.80
12034Wound repair, intermediate, 7.6–12.5 cmIntermediate repair for a similar length range in a related site group.$336.95

How 12004 has changed in Puerto Rico

12004 · Office / nonfacility

$162.98

Effective 2026-10-01

The base rate is $33.57 higher than on 2025-10-01, moving from $129.41 to $162.98 (25.9%).

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

    $129.41changed to$162.98

    • 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
    • Practice expense GPCI 1.007 changed to 1.011
    • Malpractice GPCI 0.982 changed to 0.985

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $133.84changed to$129.41

    • 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

    $131.66changed to$133.84

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $135.00changed to$131.66

    • 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
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $134.53changed to$135.00

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984

  6. January 1, 2023

    RVU23A

    $135.79changed to$134.53

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 2.20 changed to 2.26
    • Practice expense GPCI 1.008 changed to 1.000
    • Malpractice GPCI 0.986 changed to 1.000

    Held through RVU23B, RVU23C.

  7. January 1, 2022

    RVU22A

    $135.87changed to$135.79

    • 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.

  8. January 1, 2021

    RVU21A

    $133.63changed to$135.87

    • 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
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $130.53changed to$133.63

    • Conversion factor 36.0391 changed to 36.0896
    • Malpractice RVU 0.19 changed to 0.27
    • Practice expense GPCI 1.007 changed to 1.008
    • Malpractice GPCI 0.990 changed to 0.988

    Held through RVU20B, RVU20C, RVU20D.

  10. January 1, 2019

    RVU19A

    $132.93changed to$130.53

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

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $117.11changed to$132.93

    • 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
    • Practice expense GPCI 0.856 changed to 1.007
    • Malpractice GPCI 0.642 changed to 0.990

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $103.64changed to$117.11

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense GPCI 0.705 changed to 0.856
    • Malpractice GPCI 0.293 changed to 0.642

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $104.37changed to$103.64

    • 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.

  14. July 1, 2015

    RVU15C

    $103.85changed to$104.37

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $101.91changed to$103.85

    • 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
    • Practice expense GPCI 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    $101.31changed to$101.91

    • 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
    • Practice expense GPCI 0.678 changed to 0.692
    • Malpractice GPCI 0.249 changed to 0.271

    Held through RVU14B, RVU14C, RVU14D.

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: $101.31

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$162.98$72.14RVU26D
2026-07-01$162.98$72.14RVU26C
2026-04-01$162.98$72.14RVU26B
2026-01-01$162.98$72.14RVU26A
2025-10-01$129.41$70.78RVU25D
2025-07-01$129.41$70.78RVU25C
2025-04-01$129.41$70.78RVU25B
2025-01-01$129.41$70.78RVU25A
2024-10-01$133.84$73.17RVU24D
2024-07-01$133.84$73.17RVU24C
2024-04-01$133.84$73.17RVU24B
2024-03-09$133.84$73.17RVU24AR
2024-01-01$131.66$71.97RVU24A
2023-10-01$135.00$73.51RVU23D
2023-07-01$134.53$73.54RVU23C
2023-04-01$134.53$73.54RVU23B
2023-01-01$134.53$73.54RVU23A
2022-10-01$135.79$74.39RVU22D
2022-07-01$135.79$74.39RVU22C
2022-04-01$135.79$74.39RVU22B
2022-01-01$135.79$74.39RVU22A
2021-10-01$135.87$74.67RVU21D
2021-07-01$135.87$74.67RVU21C
2021-04-01$135.87$74.67RVU21B
2021-01-01$135.87$74.67RVU21A
2020-10-01$133.63$77.60RVU20D
2020-07-01$133.63$77.60RVU20C
2020-04-01$133.63$77.60RVU20B
2020-01-01$133.63$77.60RVU20A
2019-10-01$130.53$75.37RVU19D
2019-07-01$130.53$75.37RVU19C
2019-04-01$130.53$75.37RVU19B
2019-01-01$130.53$75.37RVU19A
2018-10-01$132.93$75.29RVU18D
2018-07-01$132.93$75.29RVU18C
2018-04-01$132.93$75.29RVU18B
2018-01-01$132.93$75.29RVU18AR1
2017-10-01$117.11$70.42RVU17D
2017-07-01$117.11$70.42RVU17C
2017-04-01$117.11$70.42RVU17B
2017-01-01$117.11$70.42RVU17A
2016-10-01$103.64$65.02RVU16D
2016-07-01$103.64$65.02RVU16C
2016-04-01$103.64$65.02RVU16B
2016-01-01$103.64$65.02RVU16A
2015-10-01$104.37$65.36RVU15D
2015-07-01$104.37$65.36RVU15C
2015-04-01$103.85$65.03RVU15B
2015-01-01$103.85$65.03RVU15A
2014-10-01$101.91$64.97RVU14D
2014-07-01$101.91$64.97RVU14C
2014-04-01$101.91$64.97RVU14B
2014-01-01$101.91$64.97RVU14A
2013-10-01$101.31$62.56RVU13D
2013-07-01$101.31$62.56RVU13C
2013-04-01$101.31$62.56RVU13B
2013-01-01$101.31$62.56RVU13AR

Price 12004 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

  • Aceitunas
  • Adjuntas
  • Aguada
  • Aguadilla
  • Aguas Buenas
  • Aguas Claras
  • Aguilita
  • Aibonito

Browse all communities in Puerto Rico

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 Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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