Billing code 12013: Wound repairMedicare rate & RVUs in Washington
Reports simple closure of a 2.6–5.0 cm superficial wound on the face, ears, eyelids, nose, lips, or mucous membranes.
Medicare pays $149.12–$167.95 for 12013 in the office in Washington, from Rest Of Washington to Seattle (King Cnty). 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 12013 covers
This code covers simple repair of a superficial wound in the face, ears, eyelids, nose, lips, or mucous membranes when the repaired length is 2.6–5.0 cm. The closure is limited to the superficial tissue layers; it does not involve the layered closure of deeper tissue characteristic of an intermediate repair. Emergency clinicians, surgeons, and other qualified practitioners commonly perform these repairs in emergency departments, outpatient clinics, and offices.
Select the code by the wound’s anatomic group, repair complexity, and final repaired length. For multiple simple wounds in the same classification and anatomic group, combine lengths when determining the level; document the wound sites, lengths, and closure technique. This minor procedure has a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate; assistant-at-surgery payment is statutorily restricted, and co-surgeon and team-surgery billing 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 12013 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | $149.12 | $54.51 |
| Seattle (King Cnty) | $167.95 | $57.71 |
How the 12013 rate is calculated
Each of 12013’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 · 12013
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.19Practice expense 2.90Malpractice 0.27
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 12013
The CMS indicators that decide how 12013 is paid alongside other services.
CMS payment indicators · 12013
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
12013 without 51 · national office
$145.63
Wound repair
12013-51 · Second procedure: 50%
$72.82
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%).
12013 compared with similar codes
Compare codes
12013 vs 12011 vs 12014 vs 12001 vs 12052: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 12011Wound repair
- Both codes cover simple repairs in the same anatomic group. Use 12011 when the repaired length is 2.5 cm or less; use 12013 for 2.6–5.0 cm.
- 12014Wound repair
- Both codes cover simple repairs in the same anatomic group. Use 12014 when the repaired length is 5.1–7.5 cm, rather than 2.6–5.0 cm.
- 12001Simple wound repair
- This code is for simple repairs in a different anatomic group, such as scalp, trunk, or extremities. Wounds on the face, ears, eyelids, nose, lips, or mucous membranes fall under 12013 when the length fits.
- 12052Wound repair
- Both codes cover the same anatomic group and length range, but 12052 is for an intermediate repair. Choose based on documented repair complexity, not wound length alone.
12013 billing questions
How does 12013 differ from 12011 and 12014?
These codes cover the same anatomic group and simple-repair level. Choose 12013 for a repaired length of 2.6–5.0 cm; 12011 is for shorter repairs and 12014 for longer repairs.
Can separate wound lengths be combined?
Combine lengths for multiple simple repairs in the same classification and anatomic group when selecting the length level. Document each site and length, along with the total used for code selection.
When is an intermediate repair code more appropriate?
Use an intermediate repair code when the documented repair involves layered closure of deeper tissue or otherwise meets the intermediate-repair criteria. A superficial, simple closure supports 12013 instead.
Should modifier 50 be reported for wounds on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code; do not report modifier 50 for bilateral wounds.
How does Medicare handle other procedures performed in the same session?
The highest-valued procedure is paid in full, and other procedures in the same session are subject to the standard multiple-procedure reduction. Same-day preoperative and postoperative care is included in this code’s 0-day global period.
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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