CPT code 12042: Intermediate wound repair, neck, hands, feet, or genitalia2026 Medicare rate & RVUs in Florida
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.
Medicare pays $301.01–$328.64 for 12042 in the office in Florida, from Rest of Florida to Miami, FL. 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 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.
Where 12042 pays more and less in Florida
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$301.01 to $328.64
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale, FL | $315.70 | $177.31 |
| Miami, FL | $328.64 | $186.43 |
| Rest of Florida | $301.01 | $170.41 |
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
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.
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
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 days after are 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. |
| Split (54/55/56) | 0.10/0.80/0.10 | Share 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.
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%).
12042 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 12041Intermediate repairNeck, hands, feet, genitalia, 2.5 cm or less
- Use 12041 for qualifying intermediate repairs of the same sites when the length is 2.5 cm or less; 12042 begins at 2.6 cm.
- 12032Intermediate repair2.6–7.5 cm, scalp/trunk/extremities
- Both represent intermediate repair in the 2.6–7.5 cm range, but 12032 is for the scalp, axillae, trunk, or extremities, including hands and feet, under its site grouping.
- 12052Wound repairFace, 2.6–5 cm
- Use 12052 for intermediate repairs of the face, ears, eyelids, nose, lips, or mucous membranes; 12042 is for the neck, hands, feet, or external genitalia.
- 12002Wound repairSimple, 2.6–7.5 cm
- 12002 is a simple repair code for its specified sites and length range. Choose 12042 when the documented repair meets intermediate criteria.
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
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