CPT code 12016: Simple wound repair, face group, 12.6–20 cm2026 Medicare rate & RVUs in Massachusetts
Simple closure of superficial wounds of the face, ears, eyelids, nose, lips, or mucous membranes, with a combined repair length of 12.6–20 cm.
Medicare pays $273.28–$299.91 for 12016 in the office in Massachusetts, from Rest of Massachusetts to Metropolitan Boston, MA. 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 12016 covers
This service covers straightforward, one-layer closure of superficial lacerations in the face-site group: the face, ears, eyelids, nose, lips, and mucous membranes. The wound is limited to superficial tissues rather than requiring layered repair of deeper structures. Physicians and other qualified clinicians commonly perform these repairs in emergency departments, urgent care, or office settings after injuries such as facial cuts.
Select the code using the combined length of qualifying simple repairs in this anatomic group during the session; document each wound’s site, measured length, and repair method. This length band is 12.6–20 cm. The code has a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service, and co-surgeon and team-surgery reporting 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 12016 pays more and less in Massachusetts
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Boston, MA | $299.91 | $126.43 |
| Rest of Massachusetts | $273.28 | $120.28 |
How the 12016 rate is calculated
Each of 12016’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 · 12016
RVUs × geographic indexes × conversion factor
Work2.61
2.61 RVUs× 1.000 GPCI
Practice expense4.79
4.79 RVUs× 1.000 GPCI
Malpractice0.61
0.61 RVUs× 1.000 GPCI
Adjusted RVUs
8.0100
Conversion factor
$33.4009
Medicare rate
$267.54
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 12016
The CMS indicators that decide how 12016 is paid alongside other services.
CMS payment indicators · 12016
Simple wound repair, face group, 12.6–20 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
12016 without 51 · national office
$267.54
Simple wound repair, face group, 12.6–20 cm
12016-51 · Second procedure: 50%
$133.77
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%).
12016 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 12015Simple wound repairFace and related sites, 7.6-12.5 cm
- This is the shorter length band for simple repairs in the same face-site group. Choose 12016 when the combined qualifying repair length reaches 12.6 cm.
- 12017Wound repairFace and related sites, 20.1–30 cm
- This is the next longer length band for simple repairs in the same face-site group; 12016 covers a combined length of 12.6–20 cm.
- 12005Simple wound repair12.6–20.0 cm
- This covers simple repairs in a different anatomic group at the 12.6–20 cm length band. Choose based on wound site, not length alone.
- 12031Wound repairScalp, trunk, or extremity
- This is an intermediate repair code for a different site group. Choose it when the repair meets intermediate-repair criteria, not for a superficial simple closure.
12016 billing questions
How is the 12.6–20 cm length determined when there are several facial wounds?
Add the lengths of simple repairs in the same face-site group performed during the session. Report the code matching that combined length and retain measurements for each wound.
When should 12015 or 12017 be selected instead?
Use 12015 for a shorter total length in the same site group and 12017 for a longer total length. The repair type and anatomic group remain the same.
Can modifier 50 be used for wounds on both sides of the face?
No. The CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.
How does Medicare handle other procedures performed in the same session?
The highest-valued procedure is paid in full; other procedures in that session are subject to the standard 50% multiple-procedure reduction.
Does the code include same-day follow-up care, and can an assistant surgeon be reported?
The 0-day global period includes same-day preoperative and postoperative care. Medicare does not pay an assistant at surgery for this service.
What documentation supports reporting this code rather than an intermediate repair?
Record the wound sites, individual lengths, and that the closure was a simple, one-layer repair of superficial tissue. An intermediate repair involves a different repair classification.
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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