Rpr s/n/ax/gen/trnk2.6-7.5cm

CPT code 12002 covers simple repair (stitching) of a wound between 2.6 and 7.5 centimeters long on the scalp, neck, armpits, genitals, trunk, arms, or legs. This is for straightforward lacerations that don't involve deeper tissues or complex closure techniques.

Showing rates for

National Average

Base Medicare rate

$110.95

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

1.14

PE RVU (NF)

2.07

MP RVU

0.22

Total RVU

3.43

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Always measure wound length in centimeters and document precisely—12002 covers 2.6-7.5cm; wounds 2.5cm drop to 12001 (reimbursement difference of $34.83)
Impact: $34.83 difference between 12001 ($76.12 non-facility) and 12002 ($110.95 non-facility)
When multiple lacerations in same anatomic classification are repaired, sum the lengths and bill single appropriate code rather than multiple codes
Impact: Prevents denials for duplicate billing; correct summation can upcode to 12004-12007 for higher reimbursement if total exceeds 7.5cm
Verify anatomic location carefully—hands and feet use different code series (12041-12047); face/ears/nose/lips use 12011-12018
Impact: Face repairs reimburse higher ($149.69 for 12052 vs $110.95 for 12002); incorrect location coding causes automatic denials
Document whether facility or non-facility setting—site of service significantly impacts reimbursement
Impact: $54.02 difference between non-facility ($110.95) and facility ($56.93) rates for identical service
Include wound preparation details (irrigation, debridement of minimal debris) in documentation as these are bundled into simple repair
Impact: Prevents separate billing of debridement codes (11042-11047) which will be denied as bundled; supports medical necessity
For ED claims, ensure E/M code includes modifier 25 when billed with 12002 if significant separately identifiable evaluation occurred
Impact: Recovers additional $50-200 for E/M service that would otherwise be bundled and lost

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 12002 in 2025?

The 2025 Medicare national average reimbursement for CPT 12002 is $110.95 in non-facility settings and $56.93 in facility settings. Actual payment may vary by geographic locality based on the GPCI adjustment factors for your specific MAC region.

What size wound does CPT 12002 cover?

CPT 12002 covers simple repair of wounds measuring 2.6 centimeters up to and including 7.5 centimeters in length. Wounds 2.5 cm or less should be coded as 12001, while wounds longer than 7.5 cm require codes 12004-12007 depending on total length.

Can I bill CPT 12002 with an E/M code on the same day?

Yes, you can bill an E/M code with CPT 12002 using modifier 25 on the E/M code, but only if a significant, separately identifiable evaluation and management service was performed beyond the usual pre-procedural and post-procedural work. Documentation must clearly support the separate service.

What body areas are covered by CPT 12002?

CPT 12002 applies to simple repairs on the scalp, neck, axillae (armpits), external genitalia, trunk, and extremities excluding hands and feet. Face, ears, eyelids, nose, lips, and mucous membranes use different codes (12011-12018), as do hands and feet (12041-12047).

How do I code multiple lacerations with CPT 12002?

If multiple lacerations are in the same anatomic classification (e.g., both on trunk), add the lengths together and bill one code for the total length. If lacerations are in different anatomic classifications, code each separately using modifier 59 on the secondary procedure.

What is the difference between simple, intermediate, and complex repair for billing?

Simple repair (12001-12021) involves single-layer closure of superficial wounds. Intermediate repair (12031-12057) requires layered closure or extensive cleaning. Complex repair (13100-13160) involves more than layered closure, such as scar revision, extensive undermining, or stents. CPT 12002 is strictly for simple repairs only.

What are the RVU values for CPT code 12002?

CPT 12002 has a Work RVU of 1.14, non-facility PE RVU of 2.07, facility PE RVU of 0.40, and MP RVU of 0.22, for a total non-facility RVU of 3.43. These values are multiplied by the 2025 conversion factor of 32.3465 to determine Medicare payment rates.