Rpr s/n/ax/gen/trnk >30.0 cm

CPT 12007 covers the repair of simple wounds longer than 30 centimeters on the scalp, neck, armpits, trunk, arms, or legs. This is a straightforward closure of a very long superficial wound without significant tissue damage.

Showing rates for

National Average

Base Medicare rate

$222.54

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

2.9

PE RVU (NF)

3.39

MP RVU

0.59

Total RVU

6.88

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

NCCI bundling edits

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Billing tips

Measure and document total wound length precisely; wounds between 30.0-30.5 cm qualify for 12007, while 29.9 cm drops to 12006 with $72+ lower reimbursement
Impact: Accurate measurement documentation prevents downcoding from $222.54 to approximately $150 and protects against audits
Add lengths of multiple simple repairs in same anatomic group (scalp/neck/trunk/extremities) together to reach 30+ cm threshold rather than billing separately
Impact: Billing one 12007 for combined 35 cm yields $222.54 vs billing separate smaller repairs potentially totaling only $180-200
Verify place of service; facility-based repairs receive only $140.06 vs $222.54 in non-facility settings due to PE RVU difference
Impact: Billing with incorrect POS code creates $82.48 payment variance and potential recoupment risk
Document single-layer closure technique; multi-layer closures or layered repairs require intermediate repair codes (12031-12057) regardless of length
Impact: Incorrect code selection to intermediate repair family may trigger bundling edits or denials; simple repair documentation protects 12007 billing
Bill debridement separately only when extending beyond wound edges and requiring significant additional time; simple cleaning is included in 12007
Impact: Inappropriate unbundling of included services triggers NCCI edits and automatic denial; legitimate separate debridement may add $100-300 when properly documented
Append modifier 59 when performing 12007 with same-day E/M or unrelated procedure to bypass CCI edits if procedures are truly distinct
Proper modifier use can preserve additional $150-400 for separately identifiable evaluation services that would otherwise be bundled and denied

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 12007 in 2025?

The 2025 Medicare national average reimbursement for CPT 12007 is $222.54 in non-facility settings and $140.06 in facility settings. This difference of $82.48 reflects the facility overhead costs covered by the facility payment rather than the physician payment.

How do you measure wound length for CPT 12007 billing?

For CPT 12007, add together the lengths of all simple repairs in the same anatomic classification (scalp, neck, axillae, genitalia, trunk, and/or extremities). The total combined length must exceed 30.0 cm. Measure each wound at its longest dimension before closure and document individual and total measurements in centimeters.

What is the difference between CPT 12007 and 12006?

CPT 12007 covers simple repairs greater than 30.0 cm in total length, while 12006 covers repairs between 20.1 and 30.0 cm in the same anatomic areas. The codes differ in reimbursement by approximately $72, making accurate measurement documentation critical for proper code selection.

Can you bill CPT 12007 with an E/M code on the same day?

Yes, you can bill an E/M service with CPT 12007 on the same day if the evaluation is separately identifiable from the decision to perform wound repair. Append modifier 25 to the E/M code and document the distinct evaluation components addressing other injuries, medical conditions, or assessments beyond the wound repair decision.

What are the RVU values for CPT code 12007?

CPT 12007 has a total of 6.88 RVUs broken down as follows: 2.9 work RVUs, 3.39 non-facility practice expense RVUs (0.84 facility PE RVUs), and 0.59 malpractice RVUs. These values are multiplied by the 2025 conversion factor of 32.3465 to calculate Medicare payment rates.

What anatomic locations are covered by CPT 12007?

CPT 12007 covers simple wound repairs on the scalp, neck, axillae (armpits), external genitalia, trunk (chest, abdomen, back), and extremities (arms and legs). Facial wounds use different codes (12011-12018) and cannot be combined with 12007 measurements.

When should I use intermediate repair codes instead of CPT 12007?

Use intermediate repair codes (12031-12057) instead of 12007 when wounds require layered closure involving deeper subcutaneous tissues and superficial fascia, or when extensive cleaning/debridement of contaminated wounds is necessary. Simple repairs like 12007 involve only single-layer closure of superficial wounds regardless of length.