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CPT code 12016: Simple wound repair, face group, 12.6–20 cm2026 Medicare rate & RVUs in Wisconsin

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.

CMS RVU26DEffective Oct 1, 2026One payment locality469 Medicare services in 2024

In Wisconsin, Medicare pays $246.72 for 12016 in the office and $107.53 when it’s performed in a hospital or facility.

$246.72Office (non-facility)
$107.53Hospital or facility
−7.8%vs the national office rate ($267.54)

Check a contract rate as a % of Medicare · 12016 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 12016 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Wisconsin
  2. What 12016 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 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.

How Wisconsin compares for 12016

Across 109 of 109 payment localities, the office rate for 12016 runs from $235.10 in Arkansas to $338.39 in San Benito County, CA. Wisconsin pays $246.72. The RVUs are the same everywhere; the geographic indexes change the dollars.

12016 in Wisconsin vs other payment areas
  1. Wisconsin · this page$246.72
  2. Los Angeles, CA · California$293.55+$46.83
  3. Washington, DC area · District of Columbia$303.03+$56.31
  4. Miami, FL · Florida$305.25+$58.53
  5. Chicago, IL · Illinois$295.34+$48.62
  6. Manhattan, NY · New York$310.98+$64.26
  7. Alaska · Alaska$312.38+$65.66

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

Every other payment area

12016 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$238.70$111.57
ArkansasArkansas$235.10$110.29
ArizonaArizona$259.65$118.86
Bakersfield, CACalifornia$276.59$117.35
Chico, CACalifornia$274.93$115.69
El Centro, CACalifornia$275.03$115.79
Fresno, CACalifornia$274.93$115.69
Hanford, CACalifornia$274.93$115.69

12016 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.

$235.10

$312.38

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

View every state and territory as a table
12016 office rate range by state
State / territoryOffice rate rangeLocalities
AK$312.381
AL$238.701
AR$235.101
AZ$259.651
CA$274.93–$338.3929
CO$274.361
CT$285.881
DC$303.031
DE$264.001
FL$270.75–$305.253
GA$254.17–$274.462
GU$280.881
HI$280.881
IA$241.661
ID$244.001
IL$265.09–$295.344
IN$245.391
KS$242.081
KY$248.051
LA$248.29–$260.872
MA$273.28–$299.912
MD$268.66–$303.033
ME$247.04–$258.582
MI$256.25–$275.922
MN$257.841
MO$244.93–$259.903
MS$239.981
MT$267.501
NC$249.471
ND$255.441
NE$242.551
NH$271.551
NJ$287.72–$300.022
NM$258.361
NV$264.301
NY$253.49–$320.825
OH$253.791
OK$245.881
OR$260.85–$281.482
PA$253.30–$279.602
PR$269.001
RI$272.281
SC$252.331
SD$254.011
TN$243.551
TX$251.70–$274.788
UT$255.861
VA$258.83–$303.032
VI$269.001
VT$255.881
WA$272.28–$304.492
WI$246.721
WV$255.361
WY$262.241

See 12016 in every payment locality

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

Office or facility?

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.

The exact Wisconsin inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

1,407

Code
12016
Physician work
2.61
Practice expense
4.79
Malpractice
0.61

GPCI2026.csv

111

Locality
Wisconsin
Physician work
1.000
Practice expense
0.958
Malpractice
0.308
Office calculation for 12016 in Wisconsin
ComponentRVULocality factorAdjusted
Physician work2.61× 1.0002.6100
Practice expense4.79× 0.9584.5888
Malpractice0.61× 0.3080.1879
Total RVUs7.3867
Conversion factor× 33.4009

Office rate, Wisconsin$246.72

Office: (2.61 × 1 + 4.79 × 0.958 + 0.61 × 0.308) × $33.4009 = $246.72

Facility: (2.61 × 1 + 0.44 × 0.958 + 0.61 × 0.308) × $33.4009 = $107.53

Open 12016 in the RVU calculator

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

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

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%).

When to use modifier 51

Codes related to 12016

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

Codes related to 12016
CodeHow it relatesOffice range, Wisconsin
Same family
12011Wound repair, face, 2.5 cm or lessSame face-site group and simple repair type, but for a shorter length band.$130.22
12015Simple wound repair, face and related sites, 7.6-12.5 cmSame face-site group and simple repair type, for a total length of 7.6–12.5 cm.$195.06
12017Wound repair, face and related sites, 20.1–30 cmSame face-site group and simple repair type, for a longer length band.No office rate
12018Wound repair, face group, over 30 cmSame face-site group and simple repair type, for a total length greater than 30 cm.No office rate
Used instead
12005Simple wound repair, 12.6–20.0 cmSimple repair at the same length band for a different anatomic group, including scalp, trunk, or extremities.$195.59
12031Wound repair, scalp, trunk, or extremityIntermediate repair for a different site group and repair classification, rather than simple facial-group closure.$246.69

How 12016 has changed in Wisconsin

12016 · Office / nonfacility

$246.72

Effective 2026-10-01

The base rate is $48.89 higher than on 2025-10-01, moving from $197.83 to $246.72 (24.7%).

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

    $197.83changed to$246.72

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.68 changed to 2.61
    • Practice expense RVU 3.40 changed to 4.79
    • Malpractice RVU 0.55 changed to 0.61
    • Practice expense GPCI 0.957 changed to 0.958
    • Malpractice GPCI 0.331 changed to 0.308

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $202.20changed to$197.83

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 3.36 changed to 3.40
    • Malpractice RVU 0.54 changed to 0.55

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $198.90changed to$202.20

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $206.02changed to$198.90

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 3.41 changed to 3.36
    • Malpractice RVU 0.51 changed to 0.54
    • Practice expense GPCI 0.950 changed to 0.957
    • Malpractice GPCI 0.314 changed to 0.331

  5. January 1, 2023

    RVU23A

    $207.60changed to$206.02

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 3.36 changed to 3.41
    • Malpractice RVU 0.52 changed to 0.51
    • Practice expense GPCI 0.942 changed to 0.950
    • Malpractice GPCI 0.296 changed to 0.314

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $207.25changed to$207.60

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 3.30 changed to 3.36
    • Malpractice RVU 0.51 changed to 0.52

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $204.14changed to$207.25

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 2.96 changed to 3.30
    • Malpractice RVU 0.52 changed to 0.51
    • Practice expense GPCI 0.949 changed to 0.942
    • Malpractice GPCI 0.322 changed to 0.296

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $199.98changed to$204.14

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 2.86 changed to 2.96
    • Malpractice RVU 0.38 changed to 0.52
    • Practice expense GPCI 0.957 changed to 0.949
    • Malpractice GPCI 0.347 changed to 0.322

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $197.91changed to$199.98

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 2.81 changed to 2.86
    • Malpractice RVU 0.37 changed to 0.38

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $196.08changed to$197.91

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 2.73 changed to 2.81
    • Malpractice RVU 0.38 changed to 0.37
    • Practice expense GPCI 0.956 changed to 0.957
    • Malpractice GPCI 0.457 changed to 0.347

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $197.89changed to$196.08

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 2.75 changed to 2.73
    • Malpractice RVU 0.39 changed to 0.38
    • Practice expense GPCI 0.955 changed to 0.956
    • Malpractice GPCI 0.566 changed to 0.457

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $206.01changed to$197.89

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 2.96 changed to 2.75
    • Malpractice RVU 0.40 changed to 0.39

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $204.99changed to$206.01

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $203.96changed to$204.99

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 2.89 changed to 2.96
    • Malpractice RVU 0.44 changed to 0.40
    • Practice expense GPCI 0.958 changed to 0.955
    • Malpractice GPCI 0.557 changed to 0.566

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $206.87changed to$203.96

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 3.28 changed to 2.89
    • Malpractice RVU 0.46 changed to 0.44
    • Practice expense GPCI 0.960 changed to 0.958
    • Malpractice GPCI 0.547 changed to 0.557

    Held through RVU14B, RVU14C, RVU14D.

  16. October 1, 2013

    RVU13D

    No ratechanged to$206.87

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: No rate

    Held through RVU13B, RVU13C.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$246.72$107.53RVU26D
2026-07-01$246.72$107.53RVU26C
2026-04-01$246.72$107.53RVU26B
2026-01-01$246.72$107.53RVU26A
2025-10-01$197.83$110.53RVU25D
2025-07-01$197.83$110.53RVU25C
2025-04-01$197.83$110.53RVU25B
2025-01-01$197.83$110.53RVU25A
2024-10-01$202.20$113.96RVU24D
2024-07-01$202.20$113.96RVU24C
2024-04-01$202.20$113.96RVU24B
2024-03-09$202.20$113.96RVU24AR
2024-01-01$198.90$112.10RVU24A
2023-10-01$206.02$115.88RVU23D
2023-07-01$206.02$115.88RVU23C
2023-04-01$206.02$115.88RVU23B
2023-01-01$206.02$115.88RVU23A
2022-10-01$207.60$117.96RVU22D
2022-07-01$207.60$117.96RVU22C
2022-04-01$207.60$117.96RVU22B
2022-01-01$207.60$117.96RVU22A
2021-10-01$207.25$118.17RVU21D
2021-07-01$207.25$118.17RVU21C
2021-04-01$207.25$118.17RVU21B
2021-01-01$207.25$118.17RVU21A
2020-10-01$204.14$122.28RVU20D
2020-07-01$204.14$122.28RVU20C
2020-04-01$204.14$122.28RVU20B
2020-01-01$204.14$122.28RVU20A
2019-10-01$199.98$122.38RVU19D
2019-07-01$199.98$122.38RVU19C
2019-04-01$199.98$122.38RVU19B
2019-01-01$199.98$122.38RVU19A
2018-10-01$197.91$122.12RVU18D
2018-07-01$197.91$122.12RVU18C
2018-04-01$197.91$122.12RVU18B
2018-01-01$197.91$122.12RVU18AR1
2017-10-01$196.08$123.69RVU17D
2017-07-01$196.08$123.69RVU17C
2017-04-01$196.08$123.69RVU17B
2017-01-01$196.08$123.69RVU17A
2016-10-01$197.89$124.72RVU16D
2016-07-01$197.89$124.72RVU16C
2016-04-01$197.89$124.72RVU16B
2016-01-01$197.89$124.72RVU16A
2015-10-01$206.01$129.83RVU15D
2015-07-01$206.01$129.83RVU15C
2015-04-01$204.99$129.19RVU15B
2015-01-01$204.99$129.19RVU15A
2014-10-01$203.96$130.52RVU14D
2014-07-01$203.96$130.52RVU14C
2014-04-01$203.96$130.52RVU14B
2014-01-01$203.96$130.52RVU14A
2013-10-01$206.87$125.87RVU13D
2013-07-01Rate data unavailableRate data unavailableRVU13C
2013-04-01Rate data unavailableRate data unavailableRVU13B
2013-01-01Rate data unavailableRate data unavailableRVU13AR

Price 12016 for an earlier date of service

Where the Wisconsin rate applies

Wisconsin is a Medicare payment area, not a city. Our Census mapping connects it to 807 cities and communities in Wisconsin. Some span more than one payment area; confirm with the service ZIP.

  • Abbotsford
  • Abrams
  • Adams
  • Adell
  • Albany
  • Algoma
  • Allens Grove
  • Allenton

Browse all communities in Wisconsin

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
RVUs for 12016PPRRVU2026_Oct_nonQPP.csv, line 1,407 (RVU26D)
Geographic factors for WisconsinGPCI2026.csv, line 111 (RVU26D)

Open CMS sourceHow we calculate rates

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