CPT code 12042: Intermediate wound repair, neck, hands, feet, or genitalia2026 Medicare rate & RVUs in Puerto Rico
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.
In Puerto Rico, Medicare pays $307.04 for 12042 in the office and $168.93 when it’s performed in a hospital or facility.
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.
On this page 11 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.
How Puerto Rico 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. Puerto Rico pays $307.04. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Puerto Rico · this page$307.04
- Los Angeles, CA · California$342.65+$35.61
- Washington, DC area · District of Columbia$347.31+$40.27
- Miami, FL · Florida$328.64+$21.60
- Chicago, IL · Illinois$319.58+$12.54
- Manhattan, NY · New York$349.70+$42.66
- Alaska · Alaska$359.14+$52.10
Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $275.09 | $155.56 |
| 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 |
| Merced, CACalifornia | $321.44 | $171.71 |
| Modesto, CACalifornia | $321.44 | $171.71 |
| Napa, CACalifornia | $370.64 | $190.59 |
| Oxnard, CACalifornia | $340.86 | $179.39 |
| Redding, CACalifornia | $321.44 | $171.71 |
| Rest of CaliforniaCalifornia | $321.44 | $171.71 |
| Riverside, CACalifornia | $324.70 | $174.98 |
| Sacramento, CACalifornia | $336.84 | $177.96 |
| Salinas, CACalifornia | $335.57 | $177.24 |
| San Diego, CACalifornia | $343.09 | $179.70 |
| Marin County, CACalifornia | $391.83 | $199.21 |
| San Francisco, CACalifornia | $391.49 | $198.87 |
| San Benito County, CACalifornia | $400.50 | $203.51 |
| Santa Clara County, CACalifornia | $399.10 | $202.11 |
| San Luis Obispo, CACalifornia | $330.21 | $174.61 |
| Santa Cruz, CACalifornia | $346.09 | $180.11 |
| Santa Maria, CACalifornia | $336.72 | $177.43 |
| Santa Rosa, CACalifornia | $349.56 | $181.80 |
| Stockton, CACalifornia | $321.44 | $171.71 |
| Vallejo, CACalifornia | $370.15 | $190.10 |
| Visalia, CACalifornia | $321.44 | $171.71 |
| Yuba City, CACalifornia | $321.44 | $171.71 |
| ColoradoColorado | $316.91 | $171.55 |
| ConnecticutConnecticut | $324.59 | $177.46 |
| DelawareDelaware | $301.94 | $166.97 |
| Fort Lauderdale, FLFlorida | $315.70 | $177.31 |
| Rest of FloridaFlorida | $301.01 | $170.41 |
| Atlanta, GAGeorgia | $310.50 | $171.71 |
| Rest of GeorgiaGeorgia | $284.83 | $162.98 |
| Hawaii, Guam, HIHawaii | $328.69 | $173.37 |
| IowaIowa | $281.56 | $156.56 |
| IdahoIdaho | $283.34 | $157.66 |
| East St. Louis, ILIllinois | $298.78 | $173.10 |
| Rest of IllinoisIllinois | $292.84 | $168.11 |
| Suburban Chicago, ILIllinois | $318.83 | $178.53 |
| IndianaIndiana | $284.90 | $158.26 |
| KansasKansas | $280.39 | $156.89 |
| KentuckyKentucky | $281.45 | $160.00 |
| New Orleans, LALouisiana | $294.27 | $165.72 |
| Rest of LouisianaLouisiana | $281.06 | $160.16 |
| Metropolitan Boston, MAMassachusetts | $347.16 | $184.05 |
| Rest of MassachusettsMassachusetts | $315.19 | $171.34 |
| Baltimore area, MDMaryland | $323.68 | $177.09 |
| Rest of MarylandMaryland | $307.49 | $169.24 |
| Rest of MaineMaine | $284.84 | $159.16 |
| Southern Maine, MEMaine | $299.42 | $164.04 |
| Detroit, MIMichigan | $304.68 | $172.85 |
| Rest of MichiganMichigan | $288.49 | $163.76 |
| MinnesotaMinnesota | $303.81 | $163.24 |
| Metropolitan Kansas City, MOMissouri | $292.27 | $163.99 |
| Metropolitan St. Louis, MOMissouri | $295.17 | $165.12 |
| Rest of MissouriMissouri | $276.53 | $158.77 |
| MississippiMississippi | $273.97 | $156.35 |
| MontanaMontana | $304.93 | $168.32 |
| North CarolinaNorth Carolina | $287.66 | $160.20 |
| North DakotaNorth Dakota | $299.00 | $162.39 |
| NebraskaNebraska | $283.00 | $156.91 |
| New HampshireNew Hampshire | $312.06 | $169.85 |
| Northern New JerseyNew Jersey | $344.01 | $185.54 |
| Rest of New JerseyNew Jersey | $328.33 | $179.15 |
| New MexicoNew Mexico | $290.03 | $164.75 |
| NevadaNevada | $303.48 | $166.73 |
| NYC suburbs and Long Island, NYNew York | $357.92 | $195.49 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $330.53 | $180.94 |
| Queens, NYNew York | $352.34 | $190.86 |
| Rest of New YorkNew York | $291.77 | $161.99 |
| OhioOhio | $287.28 | $162.55 |
| OklahomaOklahoma | $280.88 | $158.89 |
| Portland, OROregon | $326.49 | $174.72 |
| Rest of OregonOregon | $301.16 | $165.09 |
| Metropolitan Philadelphia, PAPennsylvania | $316.89 | $174.68 |
| Rest of PennsylvaniaPennsylvania | $287.66 | $162.26 |
| Rhode IslandRhode Island | $312.33 | $171.21 |
| South CarolinaSouth Carolina | $287.94 | $161.71 |
| South DakotaSouth Dakota | $298.30 | $161.69 |
| TennesseeTennessee | $281.74 | $157.56 |
| Austin, TXTexas | $315.83 | $171.29 |
| Beaumont, TXTexas | $285.87 | $161.56 |
| Brazoria, TXTexas | $301.64 | $166.26 |
| Dallas, TXTexas | $303.53 | $167.47 |
| Fort Worth, TXTexas | $301.62 | $166.92 |
| Galveston, TXTexas | $302.52 | $166.87 |
| Houston, TXTexas | $308.02 | $172.36 |
| Rest of TexasTexas | $293.57 | $163.93 |
| UtahUtah | $291.68 | $163.27 |
| VirginiaVirginia | $298.53 | $164.25 |
| Virgin Islands, VIUnited States Virgin Islands | $307.04 | $168.93 |
| VermontVermont | $297.96 | $162.72 |
| Rest of WashingtonWashington | $314.55 | $170.70 |
| King County, WAWashington | $353.99 | $186.36 |
| WisconsinWisconsin | $289.44 | $158.57 |
| West VirginiaWest Virginia | $282.53 | $163.82 |
| WyomingWyoming | $302.34 | $165.74 |
12042 rates by state
Office rate range in each state. Select a state to see its payment localities.
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
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $359.14 | 1 |
| AL | $275.09 | 1 |
| AR | $271.32 | 1 |
| AZ | $297.18 | 1 |
| CA | $321.44–$400.50 | 29 |
| CO | $316.91 | 1 |
| CT | $324.59 | 1 |
| DC | $347.31 | 1 |
| DE | $301.94 | 1 |
| FL | $301.01–$328.64 | 3 |
| GA | $284.83–$310.50 | 2 |
| GU | $328.69 | 1 |
| HI | $328.69 | 1 |
| IA | $281.56 | 1 |
| ID | $283.34 | 1 |
| IL | $292.84–$319.58 | 4 |
| IN | $284.90 | 1 |
| KS | $280.39 | 1 |
| KY | $281.45 | 1 |
| LA | $281.06–$294.27 | 2 |
| MA | $315.19–$347.16 | 2 |
| MD | $307.49–$347.31 | 3 |
| ME | $284.84–$299.42 | 2 |
| MI | $288.49–$304.68 | 2 |
| MN | $303.81 | 1 |
| MO | $276.53–$295.17 | 3 |
| MS | $273.97 | 1 |
| MT | $304.93 | 1 |
| NC | $287.66 | 1 |
| ND | $299.00 | 1 |
| NE | $283.00 | 1 |
| NH | $312.06 | 1 |
| NJ | $328.33–$344.01 | 2 |
| NM | $290.03 | 1 |
| NV | $303.48 | 1 |
| NY | $291.77–$357.92 | 5 |
| OH | $287.28 | 1 |
| OK | $280.88 | 1 |
| OR | $301.16–$326.49 | 2 |
| PA | $287.66–$316.89 | 2 |
| PR | $307.04 | 1 |
| RI | $312.33 | 1 |
| SC | $287.94 | 1 |
| SD | $298.30 | 1 |
| TN | $281.74 | 1 |
| TX | $285.87–$315.83 | 8 |
| UT | $291.68 | 1 |
| VA | $298.53–$347.31 | 2 |
| VI | $307.04 | 1 |
| VT | $297.96 | 1 |
| WA | $314.55–$353.99 | 2 |
| WI | $289.44 | 1 |
| WV | $282.53 | 1 |
| WY | $302.34 | 1 |
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.
The exact Puerto Rico 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
91
- Locality
- Puerto Rico
- Physician work
- 1.000
- Practice expense
- 1.011
- Malpractice
- 0.985
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.72 | × 1.000 | 2.7200 |
| Practice expense | 6.11 | × 1.011 | 6.1772 |
| Malpractice | 0.30 | × 0.985 | 0.2955 |
| Total RVUs | 9.1927 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Puerto Rico$307.04
Office: (2.72 × 1 + 6.11 × 1.011 + 0.3 × 0.985) × $33.4009 = $307.04
Facility: (2.72 × 1 + 2.02 × 1.011 + 0.3 × 0.985) × $33.4009 = $168.93
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%).
How 12042 has changed in Puerto Rico
12042 · Office / nonfacility
$307.04
Effective 2026-10-01
The base rate is $6.31 higher than on 2025-10-01, moving from $300.73 to $307.04 (2.1%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
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
January 1, 2026
RVU26A
$300.73changed to$307.04
- 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
- Practice expense GPCI 1.007 changed to 1.011
- Malpractice GPCI 0.982 changed to 0.985
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$311.82changed to$300.73
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 6.21 changed to 6.14
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$306.73changed to$311.82
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$317.01changed to$306.73
- Conversion factor 33.8872 changed to 32.7442
- Malpractice RVU 0.31 changed to 0.33
- Practice expense GPCI 1.008 changed to 1.007
- Malpractice GPCI 0.984 changed to 0.982
October 1, 2023
RVU23D
$315.49changed to$317.01
- Practice expense GPCI 1.000 changed to 1.008
- Malpractice GPCI 1.000 changed to 0.984
January 1, 2023
RVU23A
$322.35changed to$315.49
- 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
- Practice expense GPCI 1.008 changed to 1.000
- Malpractice GPCI 0.986 changed to 1.000
Held through RVU23B, RVU23C.
January 1, 2022
RVU22A
$320.81changed to$322.35
- 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.
January 1, 2021
RVU21A
$309.64changed to$320.81
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 5.44 changed to 6.05
- Malpractice GPCI 0.988 changed to 0.986
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$304.26changed to$309.64
- 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
- Practice expense GPCI 1.007 changed to 1.008
- Malpractice GPCI 0.990 changed to 0.988
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$297.76changed to$304.26
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 5.04 changed to 5.21
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$263.41changed to$297.76
- 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
- Practice expense GPCI 0.856 changed to 1.007
- Malpractice GPCI 0.642 changed to 0.990
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$229.75changed to$263.41
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 4.97 changed to 5.00
- Practice expense GPCI 0.705 changed to 0.856
- Malpractice GPCI 0.293 changed to 0.642
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$230.16changed to$229.75
- Conversion factor 35.9335 changed to 35.8043
- Malpractice RVU 0.38 changed to 0.42
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$229.02changed to$230.16
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$223.96changed to$229.02
- 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
- Practice expense GPCI 0.692 changed to 0.705
- Malpractice GPCI 0.271 changed to 0.293
Held through RVU15B.
January 1, 2014
RVU14A
$224.58changed to$223.96
- 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
- Practice expense GPCI 0.678 changed to 0.692
- Malpractice GPCI 0.249 changed to 0.271
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $224.58
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $307.04 | $168.93 | RVU26D |
| 2026-07-01 | $307.04 | $168.93 | RVU26C |
| 2026-04-01 | $307.04 | $168.93 | RVU26B |
| 2026-01-01 | $307.04 | $168.93 | RVU26A |
| 2025-10-01 | $300.73 | $191.61 | RVU25D |
| 2025-07-01 | $300.73 | $191.61 | RVU25C |
| 2025-04-01 | $300.73 | $191.61 | RVU25B |
| 2025-01-01 | $300.73 | $191.61 | RVU25A |
| 2024-10-01 | $311.82 | $195.51 | RVU24D |
| 2024-07-01 | $311.82 | $195.51 | RVU24C |
| 2024-04-01 | $311.82 | $195.51 | RVU24B |
| 2024-03-09 | $311.82 | $195.51 | RVU24AR |
| 2024-01-01 | $306.73 | $192.31 | RVU24A |
| 2023-10-01 | $317.01 | $197.11 | RVU23D |
| 2023-07-01 | $315.49 | $196.55 | RVU23C |
| 2023-04-01 | $315.49 | $196.55 | RVU23B |
| 2023-01-01 | $315.49 | $196.55 | RVU23A |
| 2022-10-01 | $322.35 | $198.17 | RVU22D |
| 2022-07-01 | $322.35 | $198.17 | RVU22C |
| 2022-04-01 | $322.35 | $198.17 | RVU22B |
| 2022-01-01 | $322.35 | $198.17 | RVU22A |
| 2021-10-01 | $320.81 | $198.76 | RVU21D |
| 2021-07-01 | $320.81 | $198.76 | RVU21C |
| 2021-04-01 | $320.81 | $198.76 | RVU21B |
| 2021-01-01 | $320.81 | $198.76 | RVU21A |
| 2020-10-01 | $309.64 | $204.14 | RVU20D |
| 2020-07-01 | $309.64 | $204.14 | RVU20C |
| 2020-04-01 | $309.64 | $204.14 | RVU20B |
| 2020-01-01 | $309.64 | $204.14 | RVU20A |
| 2019-10-01 | $304.26 | $207.72 | RVU19D |
| 2019-07-01 | $304.26 | $207.72 | RVU19C |
| 2019-04-01 | $304.26 | $207.72 | RVU19B |
| 2019-01-01 | $304.26 | $207.72 | RVU19A |
| 2018-10-01 | $297.76 | $208.22 | RVU18D |
| 2018-07-01 | $297.76 | $208.22 | RVU18C |
| 2018-04-01 | $297.76 | $208.22 | RVU18B |
| 2018-01-01 | $297.76 | $208.22 | RVU18AR1 |
| 2017-10-01 | $263.41 | $189.07 | RVU17D |
| 2017-07-01 | $263.41 | $189.07 | RVU17C |
| 2017-04-01 | $263.41 | $189.07 | RVU17B |
| 2017-01-01 | $263.41 | $189.07 | RVU17A |
| 2016-10-01 | $229.75 | $168.67 | RVU16D |
| 2016-07-01 | $229.75 | $168.67 | RVU16C |
| 2016-04-01 | $229.75 | $168.67 | RVU16B |
| 2016-01-01 | $229.75 | $168.67 | RVU16A |
| 2015-10-01 | $230.16 | $169.11 | RVU15D |
| 2015-07-01 | $230.16 | $169.11 | RVU15C |
| 2015-04-01 | $229.02 | $168.27 | RVU15B |
| 2015-01-01 | $229.02 | $168.27 | RVU15A |
| 2014-10-01 | $223.96 | $165.46 | RVU14D |
| 2014-07-01 | $223.96 | $165.46 | RVU14C |
| 2014-04-01 | $223.96 | $165.46 | RVU14B |
| 2014-01-01 | $223.96 | $165.46 | RVU14A |
| 2013-10-01 | $224.58 | $162.53 | RVU13D |
| 2013-07-01 | $224.58 | $162.53 | RVU13C |
| 2013-04-01 | $224.58 | $162.53 | RVU13B |
| 2013-01-01 | $224.58 | $162.53 | RVU13AR |
Where the Puerto Rico rate applies
Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.
- Aceitunas
- Adjuntas
- Aguada
- Aguadilla
- Aguas Buenas
- Aguas Claras
- Aguilita
- Aibonito
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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