Rpr fe/e/en/l/m 20.1-30.0 cm

CPT code 12017 covers intermediate repair of wounds on the face, ears, eyelids, nose, lips, or mucous membranes measuring 20.1 to 30.0 centimeters in total length. This involves layered closure of one or more wounds that require more than simple closure but less than complex reconstruction.

Showing rates for

National Average

Base Medicare rate

$148.79

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

3.18

PE RVU (NF)

0.75

MP RVU

0.67

Total RVU

4.6

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

NCCI bundling edits

Loading bundling edits…

Billing tips

Accurately measure and document total wound length by adding all wounds in the same anatomic grouping (face/ears/eyelids/nose/lips/mucosa) requiring intermediate repair
Impact: Incorrect length calculation is the #1 reason for downcoding; undercoding by one level (12016) results in $52.39 loss per claim
Document layered closure technique explicitly in operative note, specifying subcutaneous and dermal layer closure with suture type and technique
Impact: Lack of layered closure documentation results in downcoding to simple repair (12014), losing approximately $83 per claim
Do not add repair lengths from different anatomic groupings (facial vs trunk vs extremity); bill separate codes for different anatomic areas
Impact: Improper grouping leads to audit flags and potential recoupment; ensures compliant billing and prevents 30-50% penalty assessments
When multiple wounds are repaired using different closure types (simple, intermediate, complex), bill the most complex closure first without modifier 51, then append modifier 51 to lesser procedures
Impact: Proper sequencing maximizes reimbursement; incorrect sequencing can reduce total payment by 15-20%
Verify that debridement or wound preparation is documented as more than minimal; extensive debridement may warrant separate coding with modifier 59
Impact: When separately billable debridement (11042-11047) is appropriate and documented, can add $50-150 to claim value
For emergency department encounters, ensure modifier 25 is appended to E/M code when initial evaluation and decision to repair are documented separately from repair procedure

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 12017?

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 rate for CPT 12017 in 2025?

The 2025 Medicare national average payment rate for CPT 12017 is $148.79 for both facility and non-facility settings. This is based on a total RVU of 4.6 (Work RVU 3.18, PE RVU 0.75, MP RVU 0.67) multiplied by the 2025 conversion factor of 32.3465.

What is the difference between CPT 12017 and simple repair codes?

CPT 12017 is for intermediate repairs requiring layered closure of subcutaneous tissue and superficial fascia in addition to skin closure, with total wound length of 20.1-30.0 cm on face/ears/eyelids/nose/lips/mucosa. Simple repairs (12011-12018) involve single-layer closure only. The key distinction is layered closure technique, not just wound length.

Can I bill CPT 12017 with an E/M code on the same day?

Yes, you can bill an E/M service with CPT 12017 on the same day if a significant, separately identifiable evaluation beyond the decision to perform the repair is documented. Append modifier 25 to the E/M code and ensure documentation clearly shows the separate nature of the evaluation service.

How do I calculate total wound length for CPT 12017?

Add together the lengths of all wounds within the same anatomic grouping (face, ears, eyelids, nose, lips, mucous membranes) that require the same type of repair (intermediate). Measure each wound's longest dimension and sum them. The total must be 20.1-30.0 cm for CPT 12017. Do not combine wounds from different anatomic groupings.

What documentation is required to support CPT 12017 billing?

Required documentation includes: specific wound measurements totaling 20.1-30.0 cm, exact anatomic locations, description of layered closure technique with subcutaneous and dermal suture details, wound preparation performed, number of individual wounds, and justification for intermediate vs simple repair classification.

What are the Work RVUs for CPT code 12017?

CPT 12017 has a Work RVU of 3.18, Practice Expense RVU of 0.75 (both facility and non-facility), and Malpractice RVU of 0.67, for a total RVU of 4.6 in the 2025 Medicare Physician Fee Schedule.

Which medical specialties most commonly bill CPT 12017?

CPT 12017 is most commonly billed by emergency medicine physicians, plastic surgeons, dermatologists, facial plastic surgeons, general surgeons, and oral/maxillofacial surgeons who perform extensive intermediate repairs of facial wounds in emergency departments, surgical centers, and office-based settings.