Billing code 13120: Complex repairMedicare rate & RVUs in Illinois
Reports complex repair of a 1.1–2.5 cm wound on the scalp, arm, or leg when closure requires more than routine layered suturing.
Medicare pays $337.91–$369.38 for 13120 in the office in Illinois, from Rest Of Illinois to Chicago. 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 13120 covers
This code covers complex repair of a wound on the scalp, arm, or leg when the repair requires work beyond routine closure, such as extensive undermining, significant debridement, or scar revision. It may be performed by a surgeon, emergency physician, or other clinician managing a traumatic wound or operative defect in an office, emergency department, or facility. The site and the final repaired length must fall within this code’s range.
Choose the complex-repair family based on the documented repair work and anatomic group, not length alone. Record the wound site, repaired length, and the features supporting complexity; lengths may be combined only for wounds in the same classification and anatomic group. The code has a 10-day global period, which includes related postoperative visits during that period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and others are subject to a 50% reduction. Modifier 50 is inappropriate for this code. Medicare does not pay for 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.
Where 13120 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
4 payment localities
$337.91 to $369.38
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | $369.38 | $215.98 |
| East St. Louis | $345.26 | $204.83 |
| Rest Of Illinois | $337.91 | $198.54 |
| Suburban Chicago | $367.87 | $211.11 |
How the 13120 rate is calculated
Each of 13120’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 · 13120
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 3.15Practice expense 6.98Malpractice 0.38
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 13120
13120 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 13120
Complex repair
| 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 · 13120
Complex repair
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
13120 without 51 · national office
$351.04
Complex repair
13120-51 · Second procedure: 50%
$175.52
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%).
13120 compared with similar codes
Compare codes
13120 vs 13121 vs 13100 vs 12002 vs 13160: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 13121Complex repair
- Use 13121 for a complex scalp, arm, or leg repair measuring 2.6–7.5 cm; 13120 is limited to 1.1–2.5 cm.
- 13100Complex repair
- This is the corresponding complex-repair range for the trunk. Choose by anatomic group, not by wound length alone.
- 12002Wound repair
- This code describes simple repair of a 2.6–7.5 cm scalp or extremity wound. A longer wound does not by itself establish complex repair.
- 13160Wound closure
- 13160 addresses secondary closure of a surgical wound or dehiscence; 13120 is for complex repair of a wound in its specified anatomic group and length range.
13120 billing questions
How is 13120 distinguished from 13121?
Both cover complex repair on the scalp, arms, or legs. Use 13120 for a repaired length of 1.1–2.5 cm and 13121 for 2.6–7.5 cm.
Can wound lengths be added together?
Lengths may be combined when multiple wounds share the same repair classification and anatomic group. Document each wound’s site and length so the reported total is supported.
When is 13122 reported with 13120?
13122 is an add-on for each additional 5 cm or less of complex repair on the scalp, arms, or legs beyond the length covered by the primary code.
Are related postoperative visits separately reported during the global period?
Related postoperative visits during the 10-day global period are included in the repair.
Should modifier 50 be used for repairs on both sides?
No. The descriptor and anatomy make bilateral adjustment inappropriate for 13120.
What documentation supports reporting complex repair?
Document the anatomic site, repaired length, and specific work that makes the closure complex, such as extensive undermining, significant debridement, or scar revision.
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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