Billing code 12031: Wound repairMedicare rate & RVUs

Medicare pays $259.86 for 12031 nationally in the office and $133.27 in a hospital or facility. Local office rates run $229.76–$346.13.

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

What 12031 covers

This service is for a wound requiring more than a straightforward skin closure: the clinician closes one or more deeper tissue layers as well as the skin, or extensively cleans a heavily contaminated wound before closure. Typical settings include emergency departments, outpatient clinics, and surgical practices. The covered locations are the scalp, axillae, trunk, and extremities, but not the hands or feet. Intermediate repairs of the face and other separately classified sites use different codes.

Choose the code by the repair’s anatomic group, complexity, and documented length. For multiple intermediate wounds in the same anatomic group, add their lengths when selecting the code; report this level when the combined length is 2.5 cm or less. The note should describe the wound location and length, the layered closure or extensive cleaning, and the work performed. CMS assigns a 10-day global period, so related postoperative visits during that period are included. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Bilateral adjustment is not appropriate; assistant-at-surgery payment is statutorily 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 12031 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

12031 rates by state

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

How the 12031 rate is calculated

Each of 12031’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 12031

12031 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

12031 compared with similar codes

How to choose

12032Intermediate repair

Both codes cover intermediate repairs in the same site group. Choose 12032 when the combined length is 2.6–7.5 cm rather than 2.5 cm or less.

12041Intermediate repair

This code is for intermediate repair of the neck, hands, feet, or external genitalia. Use 12031 for the scalp, axillae, trunk, or extremities excluding hands and feet.

12001Simple wound repair

12001 describes a simple repair, generally a skin-only closure, in its applicable site group. 12031 is for intermediate repair involving layered closure or extensive cleaning of a heavily contaminated wound.

12051Facial repair

12051 is the intermediate-repair code for the face and specified facial sites. 12031 covers the scalp, axillae, trunk, and extremities excluding hands and feet.

Codes related to 12031

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