Billing code 12011: Wound repairMedicare rate & RVUs in Florida
Reports simple, superficial wound closure on the face or related sites when the repaired length is 2.5 cm or less.
Medicare pays $139.20–$155.35 for 12011 in the office in Florida, from Rest Of Florida to Miami. 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.
On this page 9 sections
What 12011 covers
This code describes simple closure of a superficial wound involving the face, ears, eyelids, nose, lips, or mucous membranes. The repair is generally a single-layer closure of skin or mucosal edges, such as a small facial laceration closed with sutures or tissue adhesive. Emergency clinicians, primary care practitioners, and surgeons commonly perform these repairs in emergency departments, offices, and urgent care settings.
Choose the code based on the wound’s location, repair complexity, and documented length. Record the site, length, depth, and closure method; combine lengths of simple repairs in the same anatomic grouping when selecting the length level. A layered closure or repair requiring more than simple closure may call for an intermediate repair code. The 0-day global period includes same-day preoperative and postoperative care. When multiple procedures occur in one session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate; assistant-at-surgery payment is restricted, and co-surgery 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 12011 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
$139.20 to $155.35
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale | $147.09 | $60.81 |
| Miami | $155.35 | $66.68 |
| Rest Of Florida | $139.20 | $57.78 |
How the 12011 rate is calculated
Each of 12011’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 · 12011
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.04Practice expense 2.91Malpractice 0.23
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 12011
The CMS indicators that decide how 12011 is paid alongside other services.
CMS payment indicators · 12011
Wound repair
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is 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. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
12011 without 51 · national office
$139.62
Wound repair
12011-51 · Second procedure: 50%
$69.81
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%).
12011 compared with similar codes
Compare codes
12011 vs 12013 vs 12001 vs 12031: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 12013Wound repair
- Both describe simple repair in the same anatomic group. Choose 12011 for a repaired length of 2.5 cm or less and 12013 for the next length level.
- 12001Simple wound repair
- This code is for simple repairs of the face and related sites. Code 12001 covers specified scalp, neck, axilla, genital, trunk, and extremity sites instead.
- 12031Wound repair
- 12011 describes simple superficial closure. Consider 12031 when the documented repair is intermediate in complexity and its anatomic site and length fit that code.
12011 billing questions
How is 12011 distinguished from 12013?
Both cover simple repairs in the same anatomic group. Use 12011 when the documented repaired length is 2.5 cm or less; 12013 is for the next length level.
Can lengths of multiple facial wounds be combined?
Combine lengths of simple repairs in the same anatomic grouping when determining the length level. Document each wound’s site and measurement.
When is an intermediate repair code more appropriate?
Use an intermediate repair code when the documented repair involves greater complexity, such as layered closure, rather than a simple superficial closure.
Should modifier 50 be appended for wounds on both sides of the face?
No. Modifier 50 is inappropriate for this code; select the code using the applicable anatomic grouping and repaired length.
Does the code include same-day care around the repair?
Yes. Its 0-day global period includes same-day preoperative and postoperative care.
Can an assistant or co-surgeon be reported for this repair?
Medicare payment for an assistant at surgery is restricted for this code. Co-surgeons and team surgery are not permitted.
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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