$214.74
This is the shorter length band for simple repairs in the same face-site group. Choose 12016 when the combined qualifying repair length reaches 12.6 cm.
On this page
CMS RVU26D · Effective 2026-10-01
12016 Simple wound repair Medicare reimbursement rates in Rhode Island
Simple closure of superficial wounds of the face, ears, eyelids, nose, lips, or mucous membranes, with a combined repair length of 12.6–20 cm. Compare 12016 office and facility rates across CMS payment localities in Rhode Island.
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 12016 in Rhode Island?
Rhode Island 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
$272.28
1 of 1 localities have a supported rate.
Payment area: Rhode Island
One mapped payment locality.
Facility setting
$122.19
1 of 1 localities have a supported rate.
Payment area: Rhode Island
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 12016: Simple facial wound repair, 12.6–20 cm
Simple closure of superficial wounds of the face, ears, eyelids, nose, lips, or mucous membranes, with a combined repair length of 12.6–20 cm.
This service covers straightforward, one-layer closure of superficial lacerations in the face-site group: the face, ears, eyelids, nose, lips, and mucous membranes. The wound is limited to superficial tissues rather than requiring layered repair of deeper structures. Physicians and other qualified clinicians commonly perform these repairs in emergency departments, urgent care, or office settings after injuries such as facial cuts.
Select the code using the combined length of qualifying simple repairs in this anatomic group during the session; document each wound’s site, measured length, and repair method. This length band is 12.6–20 cm. The code has a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in one 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. Medicare does not pay an assistant at surgery for this service, and co-surgeon and team-surgery reporting are not permitted.
CMS billing rules for 12016
- 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 RVU2.61 · 33%
- Practice expense (office) RVU4.79 · 60%
- Malpractice RVU0.61 · 8%
469
Medicare services in 2024 · #3620 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.
12016 compared with similar codes
Office rates for Rhode Island, from the same CMS release.
No office rate
This is the next longer length band for simple repairs in the same face-site group; 12016 covers a combined length of 12.6–20 cm.
$215.14
This covers simple repairs in a different anatomic group at the 12.6–20 cm length band. Choose based on wound site, not length alone.
$266.44
This is an intermediate repair code for a different site group. Choose it when the repair meets intermediate-repair criteria, not for a superficial simple closure.
Compare 12016 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
Rhode Island →
Office / nonfacility
$272.28
Facility
$122.19
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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 12016 in Rhode Island.
PPRRVU2026_Oct_nonQPP.csv
1,407
- Code
- 12016
- Physician work
- 2.61
- Practice expense
- 4.79
- Malpractice
- 0.61
GPCI2026.csv
92
- Locality
- Rhode Island
- Physician work
- 1.019
- Practice expense
- 1.033
- Malpractice
- 0.892
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.61 | × 1.019 | 2.6596 |
| Practice expense | 4.79 | × 1.033 | 4.9481 |
| Malpractice | 0.61 | × 0.892 | 0.5441 |
| Total RVUs | 8.1518 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Rhode Island$272.28
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.61 | 1.019 |
| Practice expense | 4.79 | 1.033 |
| Malpractice | 0.61 | 0.892 |
(2.61 × 1.019 + 4.79 × 1.033 + 0.61 × 0.892) × $33.4009 = $272.28
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.61 | 1.019 |
| Practice expense | 0.44 | 1.033 |
| Malpractice | 0.61 | 0.892 |
(2.61 × 1.019 + 0.44 × 1.033 + 0.61 × 0.892) × $33.4009 = $122.19
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.
12016 billing questions
How is the 12.6–20 cm length determined when there are several facial wounds?
Add the lengths of simple repairs in the same face-site group performed during the session. Report the code matching that combined length and retain measurements for each wound.
When should 12015 or 12017 be selected instead?
Use 12015 for a shorter total length in the same site group and 12017 for a longer total length. The repair type and anatomic group remain the same.
Can modifier 50 be used for wounds on both sides of the face?
No. The CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.
How does Medicare handle other procedures performed in the same session?
The highest-valued procedure is paid in full; other procedures in that session are subject to the standard 50% multiple-procedure reduction.
Does the code include same-day follow-up care, and can an assistant surgeon be reported?
The 0-day global period includes same-day preoperative and postoperative care. Medicare does not pay an assistant at surgery for this service.
What documentation supports reporting this code rather than an intermediate repair?
Record the wound sites, individual lengths, and that the closure was a simple, one-layer repair of superficial tissue. An intermediate repair involves a different repair classification.
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.
1,40412013,,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
1,40812017,,Rpr fe/e/en/l/m 20.1-30.0 cm,A,,3.10,0.74,NA,0.74,,0.78,4.62,4.62,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,40912018,,Rpr f/e/e/n/l/m >30.0 cm,A,,3.52,0.81,NA,0.81,,0.88,5.21,5.21,0,000,0.00,0.00,0.00,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,41012020,,Tx supfc wnd dehsn smpl clsr,A,,2.60,6.45,,2.32,,0.43,9.48,5.35,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
8912502,PA,01,METROPOLITAN PHILADELPHIA,1.018,1.041,1.193
9012502,PA,99,REST OF PENNSYLVANIA,1.000,0.918,0.945
9109202,PR,20,PUERTO RICO,1.000,1.011,0.985
9214412,RI,01,RHODE ISLAND,1.019,1.033,0.892
9311202,SC,01,SOUTH CAROLINA,1.000,0.924,0.850
9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336
9510312,TN,35,TENNESSEE,1.000,0.909,0.537