$127.79
Both codes cover simple repairs in the same anatomic group. Use 12011 when the repaired length is 2.5 cm or less; use 12013 for 2.6–5.0 cm.
On this page
CMS RVU26D · Effective 2026-10-01
12013 Wound repair Medicare reimbursement rates in Idaho
Reports simple closure of a 2.6–5.0 cm superficial wound on the face, ears, eyelids, nose, lips, or mucous membranes. Compare 12013 office and facility rates across CMS payment localities in Idaho.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 12013 in Idaho?
Idaho has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$133.13
1 of 1 localities have a supported rate.
Payment area: Idaho
One mapped payment locality.
Facility setting
$50.47
1 of 1 localities have a supported rate.
Payment area: Idaho
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Wound repair
About 12013: Simple repair of facial-area wound
Reports simple closure of a 2.6–5.0 cm superficial wound on the face, ears, eyelids, nose, lips, or mucous membranes.
This code covers simple repair of a superficial wound in the face, ears, eyelids, nose, lips, or mucous membranes when the repaired length is 2.6–5.0 cm. The closure is limited to the superficial tissue layers; it does not involve the layered closure of deeper tissue characteristic of an intermediate repair. Emergency clinicians, surgeons, and other qualified practitioners commonly perform these repairs in emergency departments, outpatient clinics, and offices.
Select the code by the wound’s anatomic group, repair complexity, and final repaired length. For multiple simple wounds in the same classification and anatomic group, combine lengths when determining the level; document the wound sites, lengths, and closure technique. This minor procedure has a 0-day global period, so same-day preoperative and postoperative care is 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 50% reduction. Modifier 50 is inappropriate; assistant-at-surgery payment is statutorily restricted, and co-surgeon and team-surgery billing are not permitted.
CMS billing rules for 12013
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU1.19 · 27%
- Practice expense (office) RVU2.90 · 67%
- Malpractice RVU0.27 · 6%
48.3K
Medicare services in 2024 · #793 by national volume
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.
12013 compared with similar codes
Office rates for Idaho, from the same CMS release.
$157.27
Both codes cover simple repairs in the same anatomic group. Use 12014 when the repaired length is 5.1–7.5 cm, rather than 2.6–5.0 cm.
$104.29
This code is for simple repairs in a different anatomic group, such as scalp, trunk, or extremities. Wounds on the face, ears, eyelids, nose, lips, or mucous membranes fall under 12013 when the length fits.
$289.41
Both codes cover the same anatomic group and length range, but 12052 is for an intermediate repair. Choose based on documented repair complexity, not wound length alone.
Compare 12013 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Idaho →
Office / nonfacility
$133.13
Facility
$50.47
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 12013 in Idaho.
PPRRVU2026_Oct_nonQPP.csv
1,404
- Code
- 12013
- Physician work
- 1.19
- Practice expense
- 2.90
- Malpractice
- 0.27
GPCI2026.csv
47
- Locality
- Idaho
- Physician work
- 1.000
- Practice expense
- 0.920
- Malpractice
- 0.473
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.19 | × 1.000 | 1.1900 |
| Practice expense | 2.90 | × 0.920 | 2.6680 |
| Malpractice | 0.27 | × 0.473 | 0.1277 |
| Total RVUs | 3.9857 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Idaho$133.13
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.19 | 1 |
| Practice expense | 2.9 | 0.92 |
| Malpractice | 0.27 | 0.473 |
(1.19 × 1 + 2.9 × 0.92 + 0.27 × 0.473) × $33.4009 = $133.13
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.19 | 1 |
| Practice expense | 0.21 | 0.92 |
| Malpractice | 0.27 | 0.473 |
(1.19 × 1 + 0.21 × 0.92 + 0.27 × 0.473) × $33.4009 = $50.47
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
12013 billing questions
How does 12013 differ from 12011 and 12014?
These codes cover the same anatomic group and simple-repair level. Choose 12013 for a repaired length of 2.6–5.0 cm; 12011 is for shorter repairs and 12014 for longer repairs.
Can separate wound lengths be combined?
Combine lengths for multiple simple repairs in the same classification and anatomic group when selecting the length level. Document each site and length, along with the total used for code selection.
When is an intermediate repair code more appropriate?
Use an intermediate repair code when the documented repair involves layered closure of deeper tissue or otherwise meets the intermediate-repair criteria. A superficial, simple closure supports 12013 instead.
Should modifier 50 be reported for wounds on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code; do not report modifier 50 for bilateral wounds.
How does Medicare handle other procedures performed in the same session?
The highest-valued procedure is paid in full, and other procedures in the same session are subject to the standard multiple-procedure reduction. Same-day preoperative and postoperative care is included in this code’s 0-day global period.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
1,40112007,,Rpr s/n/ax/gen/trnk >30.0 cm,A,,2.83,4.21,,0.56,,0.62,7.66,4.01,0,000,0.00,0.00,0.00,2,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,4021200F,,Seizure type& frequ docd,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
1,40312011,,Rpr f/e/e/n/l/m 2.5 cm/<,A,,1.04,2.91,,0.36,,0.23,4.18,1.63,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,40412013,,Rpr f/e/e/n/l/m 2.6-5.0 cm,A,,1.19,2.90,,0.21,,0.27,4.36,1.67,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,40512014,,Rpr f/e/e/n/l/m 5.1-7.5 cm,A,,1.53,3.27,,0.27,,0.36,5.16,2.16,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,40612015,,Rpr f/e/e/n/l/m 7.6-12.5 cm,A,,1.93,3.94,,0.33,,0.44,6.31,2.70,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,40712016,,Rpr fe/e/en/l/m 12.6-20.0 cm,A,,2.61,4.79,,0.44,,0.61,8.01,3.66,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772