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CPT code 12042: Intermediate wound repair, neck, hands, feet, or genitalia2026 Medicare rate & RVUs in Washington, DC area

Reports intermediate layered closure of a 2.6–7.5 cm wound on the neck, hand, foot, or external genitalia, or qualifying extensive cleaning of a contaminated wound.

CMS RVU26DEffective Oct 1, 2026One payment locality68.3K Medicare services in 2024

In Washington, DC area, Medicare pays $347.31 for 12042 in the office and $186.39 when it’s performed in a hospital or facility.

$347.31Office (non-facility)
$186.39Hospital or facility
+13.9%vs the national office rate ($304.95)

Check a contract rate as a % of Medicare · 12042 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 12042 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Washington, DC area
  2. What 12042 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 12042 covers

This code covers intermediate repair of wounds on the neck, hands, feet, or external genitalia when the qualifying length is 2.6–7.5 cm. It describes layered closure involving deeper tissue as well as skin, or single-layer closure of a heavily contaminated wound that requires extensive cleaning or removal of particulate matter. Emergency clinicians, surgeons, dermatologists, and other clinicians performing wound repair may report it in an office, emergency department, or outpatient facility.

Select the code using the wound’s documented length, anatomic site, and repair method. Record the site, measured length, tissue layers closed, and, for a contaminated wound closed in one layer, the extensive cleaning performed. Related postoperative visits during the 10-day global period are included. 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. Medicare does not pay an assistant at surgery, 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.

How Washington, DC area compares for 12042

Across 109 of 109 payment localities, the office rate for 12042 runs from $271.32 in Arkansas to $400.50 in San Benito County, CA. Washington, DC area pays $347.31. The RVUs are the same everywhere; the geographic indexes change the dollars.

12042 in Washington, DC area vs other payment areas
  1. Washington, DC area · this page$347.31
  2. Los Angeles, CA · California$342.65−$4.66
  3. Miami, FL · Florida$328.64−$18.67
  4. Chicago, IL · Illinois$319.58−$27.73
  5. Manhattan, NY · New York$349.70+$2.39
  6. Alaska · Alaska$359.14+$11.83
  7. Alabama · Alabama$275.09−$72.22

Other areas in District of Columbia first, then benchmark localities. Bars start at $0.

Every other payment area

12042 in every other Medicare payment locality
Payment localityOfficeFacility
ArkansasArkansas$271.32$153.97
ArizonaArizona$297.18$164.81
Bakersfield, CACalifornia$322.35$172.63
Chico, CACalifornia$321.44$171.71
El Centro, CACalifornia$321.49$171.76
Fresno, CACalifornia$321.44$171.71
Hanford, CACalifornia$321.44$171.71
Madera, CACalifornia$321.44$171.71

12042 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.

$271.32

$360.97

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

View every state and territory as a table
12042 office rate range by state
State / territoryOffice rate rangeLocalities
AK$359.141
AL$275.091
AR$271.321
AZ$297.181
CA$321.44–$400.5029
CO$316.911
CT$324.591
DC$347.311
DE$301.941
FL$301.01–$328.643
GA$284.83–$310.502
GU$328.691
HI$328.691
IA$281.561
ID$283.341
IL$292.84–$319.584
IN$284.901
KS$280.391
KY$281.451
LA$281.06–$294.272
MA$315.19–$347.162
MD$307.49–$347.313
ME$284.84–$299.422
MI$288.49–$304.682
MN$303.811
MO$276.53–$295.173
MS$273.971
MT$304.931
NC$287.661
ND$299.001
NE$283.001
NH$312.061
NJ$328.33–$344.012
NM$290.031
NV$303.481
NY$291.77–$357.925
OH$287.281
OK$280.881
OR$301.16–$326.492
PA$287.66–$316.892
PR$307.041
RI$312.331
SC$287.941
SD$298.301
TN$281.741
TX$285.87–$315.838
UT$291.681
VA$298.53–$347.312
VI$307.041
VT$297.961
WA$314.55–$353.992
WI$289.441
WV$282.531
WY$302.341

See 12042 in every payment locality

How the 12042 rate is calculated

Each of 12042’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 · 12042

RVUs × geographic indexes × conversion factor

Office or facility?

Work2.72

2.72 RVUs× 1.000 GPCI

Practice expense6.11

6.11 RVUs× 1.000 GPCI

Malpractice0.30

0.30 RVUs× 1.000 GPCI

Adjusted RVUs

9.1300

Conversion factor

$33.4009

Medicare rate

$304.95

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Washington, DC area inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

1,419

Code
12042
Physician work
2.72
Practice expense
6.11
Malpractice
0.30

GPCI2026.csv

39

Locality
Washington, DC area
Physician work
1.054
Practice expense
1.178
Malpractice
1.113
Office calculation for 12042 in Washington, DC area
ComponentRVULocality factorAdjusted
Physician work2.72× 1.0542.8669
Practice expense6.11× 1.1787.1976
Malpractice0.30× 1.1130.3339
Total RVUs10.3984
Conversion factor× 33.4009

Office rate, Washington, DC area$347.31

Office: (2.72 × 1.054 + 6.11 × 1.178 + 0.3 × 1.113) × $33.4009 = $347.31

Facility: (2.72 × 1.054 + 2.02 × 1.178 + 0.3 × 1.113) × $33.4009 = $186.39

Open 12042 in the RVU calculator

Payment rules and modifiers for 12042

12042 has a 10-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 12042

Intermediate wound repair, neck, hands, feet, or genitalia

RuleCMS valueWhat it means
Global period010Minor procedure: the day of the procedure plus 10 days after are 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.
Split (54/55/56)0.10/0.80/0.10Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 12042

Intermediate wound repair, neck, hands, feet, or genitalia

10-day global period ends

Oct 11, 2026

Covers Oct 1, 2026 through Oct 11, 2026 (11 days).

Visit on Oct 31, 2026

After the global period ends: visits and procedures are billed normally.

SurgeryVisit
Sep 28, 2026Oct 14, 2026

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

12042 without 51 · national office

$304.95

Intermediate wound repair, neck, hands, feet, or genitalia

12042-51 · Second procedure: 50%

$152.48

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 12042

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

Codes related to 12042
CodeHow it relatesOffice range, Washington, DC area
Same family
12041Intermediate repair, neck, hands, feet, genitalia, 2.5 cm or lessSame sites and repair type, for qualifying wound lengths of 2.5 cm or less.$300.62
12044Intermediate repair, neck, hands, feet, or genitaliaSame sites and repair type, for qualifying wound lengths of 7.6–12.5 cm.$443.37
Used instead
12032Intermediate repair, 2.6–7.5 cm, scalp/trunk/extremitiesIntermediate repair for a different anatomic group at the 2.6–7.5 cm length.$342.58
12052Wound repair, face, 2.6–5 cmIntermediate repair for face, ears, eyelids, nose, lips, or mucous membranes.$355.16
12002Wound repair, simple, 2.6–7.5 cmSimple repair for the same general site group and length when intermediate repair criteria are not met.$158.96

How 12042 has changed in Washington, DC area

12042 · Office / nonfacility

$347.31

Effective 2026-10-01

The base rate is $2.71 higher than on 2025-10-01, moving from $344.60 to $347.31 (0.8%).

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

    $344.60changed to$347.31

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.79 changed to 2.72
    • Practice expense RVU 6.14 changed to 6.11
    • Malpractice RVU 0.33 changed to 0.30
    • Work GPCI 1.057 changed to 1.054
    • Practice expense GPCI 1.192 changed to 1.178
    • Malpractice GPCI 1.168 changed to 1.113

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $357.40changed to$344.60

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 6.21 changed to 6.14

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $351.57changed to$357.40

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $368.25changed to$351.57

    • Conversion factor 33.8872 changed to 32.7442
    • Malpractice RVU 0.31 changed to 0.33
    • Work GPCI 1.056 changed to 1.057
    • Practice expense GPCI 1.214 changed to 1.192
    • Malpractice GPCI 1.231 changed to 1.168

  5. January 1, 2023

    RVU23A

    $379.58changed to$368.25

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 6.16 changed to 6.21
    • Malpractice RVU 0.32 changed to 0.31
    • Work GPCI 1.054 changed to 1.056
    • Practice expense GPCI 1.236 changed to 1.214
    • Malpractice GPCI 1.294 changed to 1.231

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $377.53changed to$379.58

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 6.05 changed to 6.16
    • Malpractice RVU 0.31 changed to 0.32

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $359.63changed to$377.53

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 5.44 changed to 6.05
    • Work GPCI 1.049 changed to 1.054
    • Practice expense GPCI 1.221 changed to 1.236
    • Malpractice GPCI 1.277 changed to 1.294

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $349.96changed to$359.63

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 5.21 changed to 5.44
    • Malpractice RVU 0.41 changed to 0.31
    • Work GPCI 1.045 changed to 1.049
    • Practice expense GPCI 1.205 changed to 1.221
    • Malpractice GPCI 1.261 changed to 1.277

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $342.20changed to$349.96

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 5.04 changed to 5.21

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $340.32changed to$342.20

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 5.00 changed to 5.04
    • Malpractice RVU 0.42 changed to 0.41
    • Work GPCI 1.048 changed to 1.045
    • Malpractice GPCI 1.271 changed to 1.261

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $338.66changed to$340.32

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 4.97 changed to 5.00
    • Work GPCI 1.051 changed to 1.048
    • Malpractice GPCI 1.280 changed to 1.271

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $338.05changed to$338.66

    • Conversion factor 35.9335 changed to 35.8043
    • Malpractice RVU 0.38 changed to 0.42

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $336.36changed to$338.05

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $330.61changed to$336.36

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 4.85 changed to 4.97
    • Malpractice RVU 0.39 changed to 0.38
    • Work GPCI 1.050 changed to 1.051
    • Practice expense GPCI 1.202 changed to 1.205
    • Malpractice GPCI 1.205 changed to 1.280

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $338.29changed to$330.61

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 5.47 changed to 4.85
    • Malpractice RVU 0.41 changed to 0.39
    • Work GPCI 1.049 changed to 1.050
    • Practice expense GPCI 1.198 changed to 1.202
    • Malpractice GPCI 1.130 changed to 1.205

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $338.29

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$347.31$186.39RVU26D
2026-07-01$347.31$186.39RVU26C
2026-04-01$347.31$186.39RVU26B
2026-01-01$347.31$186.39RVU26A
2025-10-01$344.60$215.43RVU25D
2025-07-01$344.60$215.43RVU25C
2025-04-01$344.60$215.43RVU25B
2025-01-01$344.60$215.43RVU25A
2024-10-01$357.40$219.72RVU24D
2024-07-01$357.40$219.72RVU24C
2024-04-01$357.40$219.72RVU24B
2024-03-09$357.40$219.72RVU24AR
2024-01-01$351.57$216.13RVU24A
2023-10-01$368.25$223.85RVU23D
2023-07-01$368.25$223.85RVU23C
2023-04-01$368.25$223.85RVU23B
2023-01-01$368.25$223.85RVU23A
2022-10-01$379.58$227.31RVU22D
2022-07-01$379.58$227.31RVU22C
2022-04-01$379.58$227.31RVU22B
2022-01-01$379.58$227.31RVU22A
2021-10-01$377.53$227.88RVU21D
2021-07-01$377.53$227.88RVU21C
2021-04-01$377.53$227.88RVU21B
2021-01-01$377.53$227.88RVU21A
2020-10-01$359.63$231.84RVU20D
2020-07-01$359.63$231.84RVU20C
2020-04-01$359.63$231.84RVU20B
2020-01-01$359.63$231.84RVU20A
2019-10-01$349.96$234.45RVU19D
2019-07-01$349.96$234.45RVU19C
2019-04-01$349.96$234.45RVU19B
2019-01-01$349.96$234.45RVU19A
2018-10-01$342.20$235.06RVU18D
2018-07-01$342.20$235.06RVU18C
2018-04-01$342.20$235.06RVU18B
2018-01-01$342.20$235.06RVU18AR1
2017-10-01$340.32$235.67RVU17D
2017-07-01$340.32$235.67RVU17C
2017-04-01$340.32$235.67RVU17B
2017-01-01$340.32$235.67RVU17A
2016-10-01$338.66$234.25RVU16D
2016-07-01$338.66$234.25RVU16C
2016-04-01$338.66$234.25RVU16B
2016-01-01$338.66$234.25RVU16A
2015-10-01$338.05$233.69RVU15D
2015-07-01$338.05$233.69RVU15C
2015-04-01$336.36$232.53RVU15B
2015-01-01$336.36$232.53RVU15A
2014-10-01$330.61$228.99RVU14D
2014-07-01$330.61$228.99RVU14C
2014-04-01$330.61$228.99RVU14B
2014-01-01$330.61$228.99RVU14A
2013-10-01$338.29$228.65RVU13D
2013-07-01$338.29$228.65RVU13C
2013-04-01$338.29$228.65RVU13B
2013-01-01$338.29$228.65RVU13AR

Price 12042 for an earlier date of service

Where the Washington, DC area rate applies

Washington, DC area is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in District of Columbia. Some span more than one payment area; confirm with the service ZIP.

  • Washington

Browse all communities in District of Columbia

12042 billing questions

How is 12042 distinguished from 12041?

Both cover intermediate repair of the same anatomic group. Use 12041 for a qualifying wound length of 2.5 cm or less and 12042 for 2.6–7.5 cm.

Can lengths of multiple wounds be combined?

For wounds of the same repair classification in the same anatomic grouping, use their combined length to select the applicable code. Document each wound’s site and measurement.

What repair details support reporting 12042?

Document the wound location and length, the layers closed, and the closure performed. For a single-layer closure, document heavy contamination and the extensive cleaning or particulate removal.

Is modifier 50 appropriate for wounds on both sides?

No. CMS identifies bilateral adjustment as inappropriate for this code; modifier 50 should not be used.

Are postoperative visits separately reported during the global period?

Related postoperative visits during the 10-day global period are included in the procedure.

How does Medicare handle other procedures performed in the same session?

The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction.

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 12042PPRRVU2026_Oct_nonQPP.csv, line 1,419 (RVU26D)
Geographic factors for Washington, DC areaGPCI2026.csv, line 39 (RVU26D)

Open CMS sourceHow we calculate rates

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