Rpr s/n/a/gen/trk12.6-20.0cm
CPT code 12005 covers simple repair of superficial wounds on the scalp, neck, armpit, genital area, trunk, or extremities when the total length of the wound(s) being closed is between 12.6 and 20.0 centimeters (approximately 5 to 8 inches).
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
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
NCCI bundling edits
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Billing tips
Always add lengths of repairs in the same classification (simple, intermediate, complex) and anatomical grouping before selecting the appropriate code
Impact: Prevents underbilling by up to $150; a 10 cm repair plus 8 cm repair = 18 cm total, coded as 12005, not two separate lower-value codes
Document the exact measured length in centimeters in the operative note, including individual wound lengths when multiple wounds are repaired
Impact: Reduces audit risk and denial rate by 40-60% according to MAC audit data; provides objective support for code selection
Verify the wound meets simple repair criteria with no deeper layer closure, minimal debridement, and no extensive contamination requiring complex preparation
Impact: Miscoding intermediate repairs (12031-12037) as simple results in underpayment of $80-200 per case
Bill in non-facility settings when performed in office or clinic to capture the higher non-facility rate of $171.76 versus facility rate of $91.22
Impact: Difference of $80.54 per procedure; ensure place of service code matches actual location
Do not separately bill for wound closure supplies, local anesthesia, or simple debridement as these are included in the repair code
Impact: Prevents denials and takebacks; unbundling violations can trigger audits with penalties of 2-3x overpayment amount
When total length exceeds 20.0 cm, use CPT 12006 instead to capture appropriate reimbursement for longer repairs
Impact: 12006 reimburses at higher rate; using 12005 for a 22 cm repair results in underpayment of approximately $40-60
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