$131.12–$145.36
Both codes cover simple repairs in the same site group; 12002 applies to a shorter combined length, while this code covers 7.6–12.5 cm.
On this page
CMS RVU26D · Effective 2026-10-01
12004 Simple wound repair Medicare reimbursement rates in Pennsylvania
Reports simple closure of a superficial wound at specified nonfacial sites when the combined repaired length is 7.6 to 12.5 cm. Compare 12004 office and facility rates across CMS payment localities in Pennsylvania.
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 12004 in Pennsylvania?
Pennsylvania has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$152.84–$169.24
2 of 2 localities have a supported rate.
Facility setting
$70.36–$75.70
2 of 2 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.
Wound repair
About 12004: Simple repair of nonfacial wounds
Reports simple closure of a superficial wound at specified nonfacial sites when the combined repaired length is 7.6 to 12.5 cm.
This code covers closure of a superficial wound without layered repair of deeper tissue. The site group includes the scalp, neck, axillae, external genitalia, trunk, and extremities; wounds of the face have a separate code series. A clinician typically cleans and prepares the wound, uses local anesthesia as needed, and closes the skin with sutures, staples, or tissue adhesive. These repairs commonly occur in emergency departments, urgent care, and office settings, performed by emergency, primary care, or surgical clinicians.
Select the code by the eligible site group and the combined length of simple repairs in that group, not by the number of wounds or closure materials. Document each wound’s site, length, depth, and repair method. The 0-day global period includes same-day preoperative and postoperative care. 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 multiple-procedure reduction. Modifier 50 is inappropriate for this code; assistant-at-surgery services are not paid, and co-surgeon and team-surgery billing are not permitted.
CMS billing rules for 12004
- 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 RVU1.40 · 29%
- Practice expense (office) RVU3.12 · 64%
- Malpractice RVU0.33 · 7%
19.9K
Medicare services in 2024 · #1151 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.
12004 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
$199.43–$220.46
Both codes cover simple repairs in the same site group; 12005 applies when the combined length exceeds this code’s range.
$199.16–$220.15
This code is for the scalp, neck, axillae, external genitalia, trunk, and extremities. Code 12015 is for the separate facial, ear, eyelid, nose, lip, and mucosal site group.
$315.53–$348.15
Both codes represent repairs in a similar length range, but 12034 is for intermediate repair, which involves layered closure or repair of deeper tissue.
Compare 12004 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.
2 of 2 payment localities
Metropolitan Philadelphia →
Office / nonfacility
$169.24
Facility
$75.70
Rest Of Pennsylvania →
Office / nonfacility
$152.84
Facility
$70.36
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12004 billing questions
How is the length selected when there are multiple wounds?
Add the lengths of simple repairs in the same anatomical grouping and select the applicable length range. Keep documentation of each wound’s location and length.
When should 12002 or 12005 be reported instead?
Use 12002 for a shorter combined repair length in this site group and 12005 for a longer one. The site group and simple-repair method remain the same.
Can this code be used for a layered closure?
No. This code describes simple closure; a repair requiring layered closure may fit an intermediate-repair code when its site and length criteria are met.
Is local anesthesia separately reported?
Local anesthesia used for the wound closure is part of the repair service, rather than a separate service under this code.
How does Medicare handle another procedure performed in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction. The 0-day global period includes same-day preoperative and postoperative care.
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.
1,39511983,,Remove/insert drug implant,A,,1.86,2.13,,0.46,,0.34,4.33,2.66,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,39612001,,Rpr s/n/ax/gen/trnk 2.5cm/<,A,,0.82,2.41,,0.32,,0.18,3.41,1.32,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,39712002,,Rpr s/n/ax/gen/trnk2.6-7.5cm,A,,1.11,2.82,,0.37,,0.24,4.17,1.72,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,39812004,,Rpr s/n/ax/gen/trk7.6-12.5cm,A,,1.40,3.12,,0.43,,0.33,4.85,2.16,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,39912005,,Rpr s/n/a/gen/trk12.6-20.0cm,A,,1.92,3.97,,0.34,,0.43,6.32,2.69,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,40012006,,Rpr s/n/a/gen/trk20.1-30.0cm,A,,2.33,4.35,,0.43,,0.51,7.19,3.27,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,40112007,,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