Intmd rpr s/a/t/ext 2.5 cm/<

CPT code 12031 covers intermediate repair of wounds on the scalp, arms, legs, or trunk that are 2.5 cm or less in length. This is a layered closure that involves deeper stitching beyond simple surface suturing.

Showing rates for

National Average

Base Medicare rate

$252.95

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

PE RVU (NF)

5.58

MP RVU

0.24

Total RVU

7.82

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

NCCI bundling edits

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Billing tips

Add lengths of all intermediate repairs in same anatomic grouping (scalp/neck/axillae/genitalia/trunk/extremities) together and bill the single appropriate code - never bill multiple codes from same family for same anatomic group
Impact: Prevents automatic denials for incorrect coding; billing 12031 twice instead of one 12032 results in underpayment of approximately $100-150
Bill in non-facility setting when performed in office or clinic to capture the $105.13 differential between non-facility rate ($252.95) and facility rate ($147.82)
Impact: Direct revenue increase of $105.13 per procedure when appropriate practice setting is used
Document layered closure technique explicitly - specify closure of subcutaneous layer with absorbable suture followed by skin closure to meet intermediate repair criteria
Impact: Prevents downcoding to simple repair (12001-12007) which pays approximately $100-150 less; audit protection worth thousands annually
When multiple wounds in different anatomic groups are repaired, bill each group separately with appropriate modifier 59 on secondary procedures
Impact: Captures full reimbursement for all repairs; failure to use modifier 59 results in denial of secondary procedures (potential loss of $147-252 per additional site)
Report E/M service with modifier 25 only when documentation supports significant separately identifiable evaluation beyond wound assessment (other injuries, medical decision-making for tetanus, antibiotics, imaging interpretation)
Impact: Additional $75-200 for appropriately documented E/M; improper use triggers audits and potential recoupment
Verify that wound length is documented as 2.5 cm or less; if 2.6-7.5 cm, must bill 12032 instead which pays approximately $120 more due to higher complexity

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Frequently asked questions

What is the difference between CPT 12031 and simple repair codes?

CPT 12031 requires layered closure of subcutaneous tissue and superficial fascia in addition to skin closure, while simple repairs (12001-12007) involve only single-layer skin closure. Intermediate repairs typically involve contaminated wounds requiring extensive cleaning or wounds requiring limited undermining for proper closure. The reimbursement difference is approximately $100-150 more for intermediate repairs.

How much does Medicare pay for CPT code 12031 in 2025?

Medicare pays $252.95 for CPT 12031 in non-facility settings (office/clinic) and $147.82 in facility settings (hospital/ASC) based on the 2025 national average rates. The difference reflects practice expense costs that facilities absorb in hospital settings.

Can I bill an E/M code with CPT 12031 on the same day?

Yes, but only when a significant, separately identifiable evaluation and management service is performed beyond the normal assessment required for the wound repair procedure. You must append modifier 25 to the E/M code and document the separate service clearly, such as evaluation of other injuries, medical conditions, or decision-making for antibiotics, tetanus, or imaging studies.

What anatomic sites are covered under CPT 12031?

CPT 12031 covers intermediate repairs on the scalp, neck, axillae, external genitalia, trunk, and extremities (arms and legs) excluding hands and feet. Hands and feet have separate CPT codes (12041-12047). Face, ears, eyelids, nose, lips, and mucous membranes also have different codes (12051-12057).

How do I bill multiple wounds repaired during the same encounter?

Add together the lengths of all intermediate repairs within the same anatomic grouping and bill a single code. For example, three wounds totaling 2.0 cm would still be billed as one unit of 12031. If wounds are in different anatomic groupings (e.g., trunk and face), bill each group separately using the appropriate CPT codes with modifier 59 on secondary procedures.

What documentation proves layered closure for CPT 12031?

Documentation must specifically describe closure of the subcutaneous tissue layer (typically with absorbable suture like Vicryl or Monocryl) followed by separate closure of the skin layer. Include the suture type and size for each layer, such as '3-0 Vicryl to approximate subcutaneous tissue, followed by 4-0 nylon for skin closure.' Generic phrases like 'wound closed in layers' may not withstand audit scrutiny.

What are the work RVUs for CPT code 12031?

CPT 12031 has 2.0 work RVUs, 5.58 practice expense RVUs (non-facility), 2.33 practice expense RVUs (facility), and 0.24 malpractice RVUs, for a total of 7.82 non-facility RVUs. These values are multiplied by the 2025 conversion factor of 32.3465 to calculate Medicare payment rates.