Rpr s/n/a/gen/trk20.1-30.0cm

CPT code 12006 is used when a healthcare provider performs a simple repair (stitches) of a wound on the scalp, neck, armpit, genitals, trunk, arms, or legs that measures between 20.1 and 30 centimeters in total length.

Showing rates for

National Average

Base Medicare rate

$199.58

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

2.39

PE RVU (NF)

3.28

MP RVU

0.5

Total RVU

6.17

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

NCCI bundling edits

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Billing tips

Measure and document the total combined length of all wounds in the same classification and anatomic grouping before debridement or closure to maximize accuracy
Impact: Accurate measurement can mean the difference between 12006 at $199.58 versus downcoding to 12005 at approximately $167; potential $32+ difference per claim
Bill the repair code that represents the total length of all wounds in the same anatomic grouping (scalp/neck/trunk/extremities) rather than separate codes for each wound
Impact: Combining measurements moves you into higher-paying length tiers; billing separately often results in lower total reimbursement and potential audit flags
Document whether repair was performed in facility or non-facility setting as the payment differential is significant ($199.58 vs $112.89)
Impact: $86.69 difference in Medicare reimbursement based on place of service; ensure POS code matches actual location
When multiple repairs are performed, bill the most complex repair first (intermediate or complex before simple) and use modifier 51 on subsequent procedures
Impact: Ensures maximum reimbursement by preventing the highest-value code from being reduced by multiple procedure rules
Do not separately bill for local anesthesia, minor debridement, or simple ligation of vessels as these are bundled into the repair code
Impact: Prevents denials and potential audit flags; unbundling can result in 100% denial of the bundled service plus potential refund demands
Verify that wound complexity truly qualifies as 'simple' rather than intermediate; single-layer closure only without layered closure of deeper tissues

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 12006 in 2025?

Medicare pays $199.58 for CPT 12006 in non-facility settings and $112.89 in facility settings based on the 2025 national average rates. The code has a total RVU value of 6.17 (2.39 work RVU, 3.28 non-facility PE RVU, 0.6 facility PE RVU, and 0.5 malpractice RVU).

How do I determine if a wound repair qualifies as simple versus intermediate?

Simple repairs (including 12006) involve single-layer closure of superficial wounds involving primarily epidermis, dermis, or subcutaneous tissue without significant deeper involvement. Intermediate repairs require layered closure of one or more deeper layers of subcutaneous tissue and superficial fascia, in addition to skin closure. If you perform multi-layer closure, the repair is intermediate (12031-12057 series), not simple.

Can I bill CPT 12006 for multiple wounds in different body areas?

Yes, CPT 12006 is specifically designed for combining wounds of the same classification (simple) located on the scalp, neck, axillae, genitalia, trunk, and/or extremities. You add together the lengths of all wounds in this anatomic grouping. However, wounds on the face, ears, eyelids, nose, lips, or mucous membranes are coded separately using the 12011-12018 series and cannot be combined with 12006.

Should I measure wounds before or after debridement for coding purposes?

According to CPT guidelines, wound measurements should be taken before debridement and closure. Measuring after debridement may result in inaccurate length documentation and potential downcoding. Document pre-debridement measurements clearly in the operative note to support the code selected.

Can I bill an E/M code on the same day as CPT 12006?

Yes, you can bill an E/M service with CPT 12006 if there is a significant, separately identifiable evaluation and management service beyond the decision to perform the repair. Append modifier 25 to the E/M code. The E/M must be clearly documented as addressing issues beyond the wound assessment and repair decision, such as evaluation of other injuries, medical conditions, or comprehensive trauma assessment.

What is the difference between CPT 12006 and 12005?

The only difference is wound length. CPT 12005 covers simple repairs of scalp, neck, axillae, genitalia, trunk, and extremities measuring 12.6 to 20.0 cm, while 12006 covers 20.1 to 30.0 cm. Both are simple, single-layer repairs in the same anatomic locations. Accurate measurement is critical as the reimbursement difference is approximately $32 for Medicare patients.

Is local anesthesia separately billable when performing CPT 12006?

No, local anesthesia is included in the wound repair code and should not be billed separately. The repair code includes local anesthesia, simple ligation of vessels, and chemical or electrocauterization of wounds not closed. Billing these separately will result in denials and may trigger audit flags for unbundling.