CPT code 12035: Wound repair, intermediate, 12.6–20 cm2026 Medicare rate & RVUs

Medicare pays $414.17 for 12035 nationally in the office and $224.45 in a hospital or facility. Local office rates run $364.71–$540.66.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 12035 covers

This code covers intermediate repair of wounds on the scalp, axillae, trunk, or extremities, excluding the hands and feet. The repair generally closes deeper subcutaneous tissue or superficial fascia as well as the skin. A heavily contaminated wound may qualify when extensive cleaning is needed, even if closure is in one layer. Emergency physicians, surgeons, and other clinicians who repair traumatic or surgical wounds may perform this service in an office, emergency department, or operating room.

Select the code by the qualifying wound site, repair complexity, and summed length of wounds in the same anatomic grouping and repair classification; the total must be 12.6 to 20.0 cm. Document each wound’s location and length, the closure technique and layers repaired, and extensive cleaning when that is the basis for intermediate repair. Related postoperative visits during the 10-day global period are included. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to a 50% reduction. Modifier 50 is not appropriate for this code. Assistant-at-surgery payment is restricted, and co-surgeons and team surgery 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 12035 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

12035 rates by state

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

How the 12035 rate is calculated

Each of 12035’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.

Payment rules and modifiers for 12035

12035 has a 10-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 51

12035 compared with similar codes

How to choose

12034Wound repairIntermediate, 7.6–12.5 cm

Both cover intermediate repair in the same general site group. Choose 12034 for a summed length of 7.6 to 12.5 cm; choose 12035 for 12.6 to 20.0 cm.

12036Wound repairIntermediate, 20.1–30 cm

Both cover intermediate repair in the same general site group. Choose 12036 when the summed length is 20.1 to 30.0 cm.

12045Intermediate wound repairNeck, hands, feet, or genitalia

This is the corresponding intermediate-repair length range for neck, hands, feet, or external genitalia; 12035 covers the scalp, axillae, trunk, and other extremities.

12016Simple wound repairFace group, 12.6–20 cm

This code describes simple repair at specified face sites in the 12.6-to-20.0-cm range. Use 12035 only for its site group when intermediate-repair criteria are met.

Codes related to 12035

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

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

Open CMS sourceHow we calculate rates