Billing code 12005: Simple wound repairMedicare rate & RVUs

Medicare pays $211.09 for 12005 nationally in the office and $89.85 in a hospital or facility. Local office rates run $185.43–$270.09.

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

What 12005 covers

This code covers straightforward, one-layer closure of superficial wounds involving the epidermis, dermis, or superficial subcutaneous tissue, without deeper structural repair. The covered sites are the scalp, neck, axillae, external genitalia, and trunk. Emergency clinicians, surgeons, and other qualified practitioners may perform these repairs in an emergency department, office, or outpatient setting. A typical case is a long, uncomplicated laceration of the trunk closed in a single layer.

Select the code using the documented repair length and covered body site. When multiple wounds belong to the same repair category and anatomic grouping, combine their lengths for code selection; document each wound’s location, length, and closure technique. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When other 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. Assistant-at-surgery services are not paid, 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 12005 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

12005 rates by state

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

How the 12005 rate is calculated

Each of 12005’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 12005

The CMS indicators that decide how 12005 is paid alongside other services.

What modifiers do to the payment

When to use modifier 51

12005 compared with similar codes

How to choose

12004Simple wound repair

Use 12004 for simple repairs at the covered body sites when the applicable total length is 7.6–12.5 cm; this code begins at 12.6 cm.

12006Simple wound repair

Use 12006 for simple repairs at the covered body sites when the applicable total length is 20.1–30.0 cm; this code ends at 20.0 cm.

12035Wound repair

12035 describes intermediate repair at its covered sites, requiring a different repair approach such as layered closure. This code is for simple one-layer repair.

12016Simple wound repair

Both codes cover simple repair lengths of 12.6–20.0 cm, but 12016 is for specified facial and related sites; this code covers the scalp, neck, axillae, external genitalia, and trunk.

Codes related to 12005

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