$469.79–$575.25
This code applies to repaired lengths of 1.1 to 2.5 cm. Use 13152 for the same anatomic group when the repaired length is 2.6 to 7.5 cm.
On this page
CMS RVU26D · Effective 2026-10-01
13151 Complex repair Medicare reimbursement rates in New York
Report this service for a complex repair of a wound on an eyelid, nose, ear, or lip when the repaired length is 1.1 to 2.5 cm. Compare 13151 office and facility rates across CMS payment localities in New York.
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 13151 in New York?
New York has 5 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 5 payment areas shown below, using the same CMS release.
Office / nonfacility
$401.16–$491.90
5 of 5 localities have a supported rate.
Facility setting
$224.42–$270.70
5 of 5 localities have a supported rate.
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.
Where 13151 pays more and less in New York
5 payment localities
$401.16 to $491.90
Wound repair
About 13151: Complex eyelid, nose, ear, or lip repair
Report this service for a complex repair of a wound on an eyelid, nose, ear, or lip when the repaired length is 1.1 to 2.5 cm.
This service covers a complex repair of a wound on an eyelid, nose, ear, or lip, with a repaired length of 1.1 to 2.5 cm. It may be performed for a traumatic laceration or another wound requiring work beyond routine layered closure, such as extensive undermining, substantial wound preparation, or scar revision. Surgeons, plastic surgeons, dermatologic surgeons, and emergency clinicians may perform these repairs in office or facility settings.
Choose the code by the wound’s anatomic site, complexity, and repaired length. Document the location, length, wound characteristics, and additional work that supports complex repair. Related postoperative visits during the 10-day global period are included. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery, and co-surgery and team surgery are not permitted.
CMS billing rules for 13151
- Global period
- Minor procedure with a 10-day global period: related postoperative visits for 10 days are 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 RVU4.23 · 34%
- Practice expense (office) RVU7.82 · 62%
- Malpractice RVU0.50 · 4%
29.8K
Medicare services in 2024 · #978 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.
13151 compared with similar codes
Office rates for New York, from the same CMS release.
$270.16–$333.37
Both cover repairs in the same general anatomic group, but 12051 is for intermediate repair. Choose 13151 only when the wound and repair work meet complex-repair criteria.
$132.47–$166.79
This code is for simple repair of a short wound in the same general anatomic group. It does not represent the additional work required for complex repair.
Compare 13151 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.
5 of 5 payment localities
Manhattan →
Office / nonfacility
$480.32
Facility
$264.14
Nyc Suburbs/Long Island →
Office / nonfacility
$491.90
Facility
$270.70
Poughkpsie/N Nyc Suburbs →
Office / nonfacility
$453.86
Facility
$250.14
Queens →
Office / nonfacility
$483.14
Facility
$263.24
Rest Of New York →
Office / nonfacility
$401.16
Facility
$224.42
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13151 billing questions
How is this code distinguished from 13152?
Both describe complex repair in the same anatomic group. Use 13151 for a repaired length of 1.1 to 2.5 cm; 13152 covers the next length range, 2.6 to 7.5 cm.
When is 13151 appropriate instead of 12051?
Use 13151 when the repair meets the criteria for complex repair. Code 12051 is for an intermediate repair in the same general anatomic group, not a complex repair.
What wound details should the record include?
Document the specific site, repaired length, and wound features or repair work supporting complexity, such as extensive undermining or substantial wound preparation.
Can 13153 be reported with 13151?
13153 is the add-on code for each additional length increment beyond the initial repair range. Report it with the appropriate primary complex-repair code when the documented total repaired length supports it.
Can modifier 50 or an assistant-at-surgery claim be used?
Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery for this service.
Are related postoperative visits separately reported?
Related postoperative visits during the 10-day global period are included in the procedure payment.
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.
1,43913131,,Cmplx rpr f/c/c/m/n/ax/g/h/f,A,,3.64,7.44,,2.04,,0.43,11.51,6.11,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,44013132,,Cmplx rpr f/c/c/m/n/ax/g/h/f,A,,4.66,8.67,,2.35,,0.51,13.84,7.52,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,44113133,,Cmplx rpr f/c/c/m/n/ax/g/h/f,A,,2.14,2.62,,0.65,,0.27,5.03,3.06,0,ZZZ,0.00,0.00,0.00,0,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,44213151,,Cmplx rpr e/n/e/l 1.1-2.5 cm,A,,4.23,7.82,,2.25,,0.50,12.55,6.98,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,44313152,,Cmplx rpr e/n/e/l 2.6-7.5 cm,A,,5.21,8.87,,2.52,,0.61,14.69,8.34,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,44413153,,Cmplx rpr e/n/e/l addl 5cm/<,A,,2.32,2.98,,0.72,,0.36,5.66,3.40,0,ZZZ,0.00,0.00,0.00,0,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,44513160,,Sec clsr surg wnd/dehsn xtn,A,,11.74,8.34,NA,8.34,,2.10,22.18,22.18,0,090,0.10,0.71,0.19,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00