CPT 13100Surgery

Cmplx rpr trunk 1.1-2.5 cm

CPT code 13100 covers the complex surgical repair of a wound on the trunk (chest, back, or abdomen) that measures between 1.1 and 2.5 centimeters. This involves layered closure requiring more than simple stitching due to the wound's depth or complexity.

Showing rates for

National Average

Base Medicare rate

$328.32

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)

6.76

MP RVU

0.39

Total RVU

10.15

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

NCCI bundling edits

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Billing tips

Ensure documentation clearly indicates layered closure technique and involvement of subcutaneous tissue/fascia, not just skin closure
Impact: Prevents downcoding to simple repair codes (12001-12007) which reimburse $80-120 less, representing a $208-248 loss per claim
Measure and document wound size after debridement and before closure, as excised diameter determines code selection
Impact: Accurate measurement ensures correct code selection; a 2.6 cm repair should use 13101 (+$133.09 add-on) rather than being undervalued
Bill in non-facility settings (office-based procedures) when possible to capture the higher non-facility rate
Impact: Non-facility rate of $328.32 versus facility rate of $195.37 yields $132.95 additional revenue per procedure
Do not separately bill for simple wound closure or local anesthesia when performing complex repair
Impact: These services are bundled; attempting to bill separately triggers NCCI edits resulting in automatic denial and potential audit flags
When multiple complex repairs are performed, list them in descending RVU order with 13100 as primary if it has highest value
Impact: Primary procedure receives 100% reimbursement ($328.32), while secondary procedures receive 50% due to modifier 51, maximizing total payment
Append modifier 25 to same-day E/M services in ED or office settings with clear documentation of separate medical decision-making
Impact: Captures additional $75-200 for E/M service that would otherwise be bundled and denied without the modifier

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Frequently asked questions

What is the difference between CPT 13100 and simple repair codes?

CPT 13100 requires layered closure of subcutaneous tissue and fascia in addition to skin closure, while simple repairs (12001-12007) involve only epidermis, dermis, or subcutaneous tissue without significant involvement of deeper structures. Complex repairs also typically require debridement, extensive cleaning, or creation of defects requiring advanced closure techniques. The reimbursement difference is substantial: $328.32 for 13100 versus approximately $120 for comparable simple repairs.

How much does Medicare pay for CPT code 13100 in 2025?

Medicare pays $328.32 for CPT 13100 in non-facility settings (physician office) and $195.37 in facility settings (hospital) based on the 2025 national average rates. Actual payment may vary by geographic location due to locality adjustments. The code has a total RVU value of 10.15 with the 2025 conversion factor of 32.3465.

Can I bill CPT 13100 with an excision code on the same day?

Generally no, unless the repair is at a completely separate anatomic site. Complex repair is typically bundled with excision codes under NCCI edits, as closure is considered part of the excision procedure. If performing repair at a distinct site unrelated to the excision, append modifier 59 to 13100 and document the separate locations clearly. Without modifier 59 and proper documentation, the claim will be denied as bundled.

What documentation is required to support billing CPT 13100?

Documentation must include: anatomic location on trunk, wound size after debridement (1.1-2.5 cm for 13100), detailed description of layered closure technique specifying closure of subcutaneous tissue/fascia separately from skin, complexity factors requiring advanced technique, suture types used for each layer, and medical necessity/cause of wound. Failure to document layered closure typically results in downcoding to simple repair.

What are the RVU values for CPT code 13100?

CPT 13100 has Work RVU of 3.00, Practice Expense RVU of 6.76 (non-facility) or 2.65 (facility), and Malpractice RVU of 0.39, for a total of 10.15 RVUs non-facility or 6.04 RVUs facility setting. These RVUs multiplied by the 2025 conversion factor of 32.3465 yield the Medicare payment rates.

Can CPT 13100 be billed by nurse practitioners or physician assistants?

Yes, qualified non-physician practitioners (NPPs) including nurse practitioners and physician assistants can bill CPT 13100 if they have appropriate surgical privileges, credentialing, and work within their scope of practice as defined by state law. Medicare typically reimburses NPPs at 85% of the physician fee schedule rate unless they are billing incident-to a physician, which requires direct physician supervision but allows 100% reimbursement.

What is the size range for CPT 13100 trunk repairs?

CPT 13100 covers complex repairs of the trunk measuring 1.1 cm to 2.5 cm in length. Wounds 1.0 cm or less are not separately reportable as complex repairs of this size are bundled into E/M services. Wounds larger than 2.5 cm require add-on code 13101 for each additional 5 cm or less beyond the initial 2.5 cm. Accurate measurement after debridement is critical for correct code selection.