Rpr f/e/e/n/l/m 2.5 cm/<

CPT 12011 covers simple repair of superficial wounds on the face, ears, eyelids, nose, lips, or mucous membranes that are 2.5 centimeters or less in length. This includes basic stitching of small cuts that don't involve deeper tissue layers.

Showing rates for

National Average

Base Medicare rate

$109.01

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

1.07

PE RVU (NF)

2.09

MP RVU

0.21

Total RVU

3.37

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

NCCI bundling edits

Loading bundling edits…

Billing tips

Measure and document total wound length after debridement and before closure, not initial presentation length
Impact: Incorrect measurement can result in downcoding from higher-paying codes (12013-12018) or upcoding denials, representing $50-$200+ difference
Add lengths of repairs in same anatomic classification and complexity together; bill as single code representing total length
Impact: Multiple 1 cm facial repairs totaling 3 cm should be billed as 12013 ($164.31) not multiple 12011 units, increasing reimbursement by approximately $55
Document wound complexity indicators: do not bill 12011 if layered closure, extensive undermining, or retention sutures are required
Impact: Intermediate repairs (12051-12057) reimburse $138-$350+ versus $109.01 for simple repair; proper complexity documentation captures appropriate value
Bill appropriate setting: facility rate ($54.02) applies in hospital ED/ASC; non-facility rate ($109.01) in office/clinic
Impact: Using correct place of service prevents $55 overpayment recovery or underpayment; affects practice vs facility revenue allocation
Do not separately bill local anesthesia, closure materials, or wound cleaning/preparation; bundled into repair code
Impact: Prevents denials and audit flags; supplies included in practice expense RVU (2.09 non-facility)
When billing with E/M using modifier 25, document medical decision-making separate from repair (evaluation of other injuries, tetanus status, etc.)
Impact: Insufficient documentation results in E/M denial; proper documentation captures additional $50-$200 for separate evaluation

Live Field Datano reports yet

Real billers contribute denial patterns and appeal strategies for this code. Once 5+ reports come in, you’ll see live aggregated data here — the only place this exists, free.

Working with CPT 12011?

Get the free Revenue Protection Toolkit — the denial triggers, modifier pitfalls, and bundling conflicts that quietly cost you reimbursement. Instant download.

Help build the field knowledge

MedPayIQ gets smarter as billers contribute. If you've had this code denied, share what happened so others learn from it. Anonymous, no patient info.

Related actions

Frequently asked questions

What is the Medicare reimbursement for CPT 12011 in 2025?

Medicare pays $109.01 for CPT 12011 in non-facility settings and $54.02 in facility settings based on the 2025 national average rates. The lower facility rate reflects that the hospital/ASC provides supplies and overhead costs.

Can I bill an E/M code with CPT 12011 on the same date of service?

Yes, you can bill an E/M code with CPT 12011 using modifier 25 on the E/M service, but only if the evaluation and management service is significant and separately identifiable from the decision to perform the repair. Documentation must clearly show medical decision-making beyond the laceration repair itself, such as evaluation of other injuries or medical conditions.

How do I measure wound length for CPT 12011?

Measure the wound length after preparation and debridement but before closure. The maximum length for 12011 is 2.5 cm or less. If multiple wounds in the same anatomic classification (facial area) are repaired, add the lengths together and bill the single code that corresponds to the total length.

What is the difference between CPT 12011 and 12051?

CPT 12011 is for simple repair requiring single-layer closure, while 12051 is for intermediate repair requiring layered closure of one or more deeper layers and superficial tissues. Intermediate repairs (12051) reimburse significantly higher at approximately $138+ versus $109.01 for simple repairs. The clinical documentation must support the complexity level billed.

What anatomic sites are covered under CPT 12011?

CPT 12011 covers simple repairs of the face, ears, eyelids, nose, lips, and mucous membranes only. Wounds on the scalp, neck, axillae, trunk, or extremities require different codes (12001-12007 series) even if the same length and complexity.

How many RVUs is CPT 12011 worth in 2025?

CPT 12011 has a total of 3.37 RVUs: 1.07 work RVUs, 2.09 practice expense RVUs (non-facility), 0.39 practice expense RVUs (facility), and 0.21 malpractice RVUs. These RVUs multiplied by the 2025 conversion factor of 32.3465 determine Medicare payment.

Can I bill CPT 12011 multiple times for multiple lacerations?

No, you cannot bill CPT 12011 multiple times for multiple lacerations in the same anatomic grouping. Instead, add the lengths of all simple repairs on the face/ears/eyelids/nose/lips/mucous membranes together and bill the single appropriate code for the total length. For repairs in different anatomic classifications, you may bill separate codes with appropriate modifiers.