Rpr s/n/ax/gen/trk7.6-12.5cm

CPT 12004 covers simple stitching of wounds between 7.6 and 12.5 centimeters (about 3 to 5 inches) on the scalp, neck, underarms, trunk, or genital area. This is a straightforward, one-layer repair of clean cuts without complications.

Showing rates for

National Average

Base Medicare rate

$129.06

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

1.44

PE RVU (NF)

2.27

MP RVU

0.28

Total RVU

3.99

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

NCCI bundling edits

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Billing tips

Measure wound length precisely before repair begins and document exact measurement in centimeters; wounds at threshold (7.5cm vs 7.6cm or 12.5cm vs 12.6cm) dramatically affect code selection
Impact: Accurate measurement prevents downcoding from 12004 to 12002 (saving $47.41) or upcoding denials from selecting 12005 instead
When multiple wounds are repaired in same anatomic grouping, add lengths together and bill single code for total length rather than multiple smaller codes
Impact: Prevents unbundling denials and optimizes reimbursement; three 4cm repairs (total 12cm) should be billed as one 12004 at $129.06, not three instances of a smaller code
Verify place of service matches facility vs non-facility status; office-based repairs should use POS 11 to capture full $129.06 non-facility rate
Impact: $58.22 difference between non-facility ($129.06) and facility ($70.84) rates makes POS coding critical
Document wound location explicitly using anatomic terms matching CPT descriptor (scalp, neck, axillae, genitalia, trunk); avoid ambiguous terms like 'shoulder' which could be classified differently
Impact: Prevents medical necessity denials and ensures wounds are properly categorized in the correct anatomic payment group
Simple repairs include local anesthesia and simple debridement; do not separately bill 64400-series nerve blocks or 11042-series debridement unless extensive and clearly documented as beyond simple wound prep
Impact: Avoids unbundling denials and potential recovery demands; local anesthesia and basic cleaning are included in the $129.06 payment
For repairs performed within 10-day global period of excision or other procedures, ensure documentation supports either staged procedure or unrelated trauma to justify separate billing

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Frequently asked questions

What is the CPT code 12004 used for?

CPT 12004 is used for simple repair of wounds 7.6 to 12.5 cm in length located on the scalp, neck, armpits, trunk, genitals, arms, or legs (excluding hands and feet). Simple repair means single-layer closure of superficial wounds without deep tissue involvement.

How much does Medicare pay for CPT 12004 in 2025?

Medicare pays $129.06 for CPT 12004 when performed in non-facility settings (physician offices) and $70.84 when performed in facility settings (hospital outpatient departments or ASCs) based on the 2025 national average rates.

Can I bill CPT 12004 with an E/M code on the same day?

Yes, you can bill an E/M code with CPT 12004 if the evaluation and management service is significant and separately identifiable from the wound repair. You must append modifier 25 to the E/M code and document the distinct nature of the evaluation beyond wound assessment.

How do I measure wound length for CPT 12004?

Measure the wound length in centimeters before beginning the repair, documenting the exact measurement in the medical record. For multiple wounds in the same anatomic grouping (e.g., multiple trunk lacerations), add the lengths together and bill a single code representing the total combined length.

What is the difference between CPT 12004 and 12002?

CPT 12002 covers simple repairs of 2.6 to 7.5 cm in the same anatomic areas, while CPT 12004 covers 7.6 to 12.5 cm. The distinction is based solely on wound length, with 12004 reimbursing at $129.06 compared to 12002's lower rate due to the larger wound size and increased complexity.

What anatomic areas are included in CPT 12004?

CPT 12004 includes scalp, neck, axillae (armpits), external genitalia, trunk (chest, abdomen, back), and extremities (arms and legs) excluding hands and feet. Face, ears, eyelids, nose, lips, mucous membranes, hands, and feet require different repair codes from separate CPT families.

Does CPT 12004 include anesthesia and wound cleaning?

Yes, CPT 12004 includes local anesthesia (such as lidocaine injection) and simple wound preparation including basic irrigation and debridement. You cannot separately bill for local anesthetic administration or routine wound cleaning as these are bundled into the repair code's reimbursement.