Intmd rpr n-hf/genit >30.0cm

CPT 12047 covers intermediate repair of lacerations or wounds on the arms, legs, or body (not face/genitals) that are longer than 30 centimeters (about 12 inches). This involves layered closure of deeper tissue and skin requiring more complex wound preparation than simple stitches.

Showing rates for

National Average

Base Medicare rate

$533.07

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

4.95

PE RVU (NF)

10.27

MP RVU

1.26

Total RVU

16.48

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

NCCI bundling edits

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Billing tips

Accurately measure and document total wound length for all repairs in the same anatomic group; combine lengths of multiple wounds in the same classification
Impact: 12047 requires >30cm total length; falling short by even 1cm drops to 12046 ($399.27), resulting in $133.80 revenue loss per case
Document layered closure technique explicitly, including closure of subcutaneous tissue and fascia layers separately from skin closure
Impact: Without documented layered closure, payers downcode to simple repair (12007 at $127.52), causing $405.55 loss per claim
Bill in non-facility settings when possible; office-based wound care yields significantly higher reimbursement
Impact: Non-facility rate ($533.07) pays $187.61 more than facility rate ($345.46), representing 54% higher reimbursement
Use separate codes for repairs in different anatomic groups (face/hands/feet vs. extremities/trunk) rather than combining lengths
Impact: Intermediate repair codes are site-specific; improper grouping leads to undercoding and potential loss of $200-400 per encounter
Document medical necessity for extensive repairs including mechanism of injury, wound contamination status, and reason for layered closure
Impact: Prevents medical necessity denials which require time-consuming appeals; proper initial documentation saves 15-20% of claims from review
Consider billing debridement separately (11042-11047) only when extensive and clearly beyond limited debridement included in repair
Impact: Separately billable debridement can add $100-300, but unbundling violations trigger audits; document as distinct procedure with separate operative note

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 12047 in 2025?

The 2025 Medicare national average reimbursement for CPT 12047 is $533.07 in non-facility settings and $345.46 in facility settings. The code has a total RVU of 16.48 (Work RVU: 4.95, Non-facility PE RVU: 10.27, Facility PE RVU: 4.47, MP RVU: 1.26) multiplied by the 2025 conversion factor of 32.3465.

How long does a wound need to be to qualify for CPT 12047?

CPT 12047 requires intermediate repair of wounds on the extremities and/or trunk totaling greater than 30.0 cm in combined length. If multiple wounds are repaired in the same anatomic classification, their individual lengths are summed together. If the total is 30.0 cm or less, you must use code 12046 instead.

Can I bill CPT 12047 for face or hand lacerations?

No, CPT 12047 specifically excludes repairs of the face, ears, eyelids, nose, lips, mucous membranes, hands, feet, and genitalia. This code is only for intermediate repairs on the neck, extremities (arms and legs excluding hands and feet), and trunk (chest, abdomen, back). Facial repairs use codes 12051-12057, and hand/foot repairs use codes 12041-12047.

What makes a repair 'intermediate' versus 'simple' for billing purposes?

Intermediate repair requires layered closure of one or more deeper layers (subcutaneous tissue and superficial fascia) in addition to skin closure. Simple repair involves closure of epidermis, dermis, or subcutaneous tissue without significant involvement of deeper structures and requires simple one-layer closure. Documentation must explicitly describe closure of multiple distinct tissue layers to support intermediate classification.

Can I bill CPT 12047 with an E/M code on the same day?

Yes, but you must append modifier 25 to the E/M code and document a significant, separately identifiable evaluation and management service beyond the wound assessment inherent to the repair procedure. The E/M must address other medical issues, comprehensive trauma evaluation, or medical decision-making distinct from the repair itself. Both services must be clearly documented separately in the medical record.

How do I combine multiple wound lengths for CPT 12047?

Measure each individual wound and add together all wounds in the same anatomic classification (intermediate repair of extremities/trunk) repaired during the same session. For example, a 15 cm laceration on the right arm plus an 18 cm laceration on the left leg equals 33 cm total, qualifying for 12047. Do not combine wounds from different anatomic groups (e.g., face wounds are coded separately from extremity wounds).

What documentation is needed to avoid denials for CPT 12047?

Essential documentation includes: specific anatomic location, individual wound measurements in centimeters with total calculation exceeding 30 cm, detailed description of layered closure technique (documenting closure of subcutaneous/fascia layers separately from skin), suture materials used for each layer, mechanism of injury, and wound preparation performed. A wound diagram or body map significantly strengthens documentation. Lack of measured lengths or layered closure description are the most common reasons for downcoding or denial.