Billing code 12005: Simple wound repairMedicare rate & RVUs in Iowa
Reports simple, one-layer closure of superficial wounds on specified body sites when the combined repair length falls between 12.6 and 20.0 cm.
Medicare pays $191.16 for 12005 in the office in Iowa (Iowa). 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 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.
12005 in Iowa
| Payment locality | Office | Facility |
|---|---|---|
| Iowa | $191.16 | $80.22 |
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.
How the rate is built · 12005
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.92Practice expense 3.97Malpractice 0.43
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 12005
The CMS indicators that decide how 12005 is paid alongside other services.
CMS payment indicators · 12005
Simple 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
12005 without 51 · national office
$211.09
Simple wound repair
12005-51 · Second procedure: 50%
$105.55
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%).
12005 compared with similar codes
Compare codes
12005 vs 12004 vs 12006 vs 12035 vs 12016: national Medicare rates
Swap in your local Medicare rate.
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.
12005 billing questions
How is this code distinguished from 12004 or 12006?
All three cover simple repairs at the same general body sites. Choose by the documented total repair length: 12004 covers 7.6–12.5 cm, this code covers 12.6–20.0 cm, and 12006 covers 20.1–30.0 cm.
Can the lengths of multiple wounds be combined?
Combine lengths when the wounds are in the same repair category and anatomic grouping. Record the location and length of each wound so the reported total can be supported.
When would 12035 be considered instead?
Consider 12035 for an intermediate repair in its covered sites, such as the scalp, axilla, or trunk, when the wound requires layered closure rather than a simple one-layer repair. The repair method and documented complexity, not length alone, distinguish the codes.
Is modifier 50 appropriate for repairs on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code; report the repair based on the applicable wound lengths and sites rather than applying modifier 50.
What same-day care is included, and how are other procedures handled?
The 0-day global period includes same-day preoperative and postoperative care. If other procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard multiple-procedure reduction.
Can an assistant or additional surgeon be reported for this repair?
Assistant-at-surgery services are not paid for this code. CMS also does not permit co-surgeons or team surgery.
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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