CPT 13152Surgery

Cmplx rpr e/n/e/l 2.6-7.5 cm

CPT 13152 covers complex repair of wounds on the face, neck, ears, eyelids, or lips that are 2.6 to 7.5 centimeters long. This involves layered closure requiring more than simple stitching due to wound depth, contamination, or tissue damage.

Showing rates for

National Average

Base Medicare rate

$478.40

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

5.34

PE RVU (NF)

8.81

MP RVU

0.64

Total RVU

14.79

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

NCCI bundling edits

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Billing tips

Always document total length of all repairs in the same complexity category and anatomic grouping. For multiple complex repairs on face/neck, add lengths together and bill one comprehensive code rather than multiple codes.
Impact: Prevents claim denials and optimizes reimbursement; billing separately when lengths should be combined results in automatic denial of secondary repairs
Document specific evidence of complexity: depth requiring layered closure, extent of contamination requiring debridement, undermining performed (in cm), tissue rearrangement, or retention sutures used. Simple descriptors like 'complex repair' are insufficient.
Impact: Prevents downcoding to simple repair codes (12051-12057) which pay $200-280 less per repair; proper documentation protects the $154-$200 differential
When performing repair after Mohs surgery or lesion excision, ensure repair is billed separately only if excision code descriptor does not include 'simple closure.' Bill same-day excision with appropriate modifier 59 if repairs meet distinctness criteria.
Impact: Avoids bundling denials that would result in loss of entire $478.40 reimbursement
For repairs spanning 2.5 cm to just over 7.5 cm, measure precisely and document exact length. Repairs at 2.5 cm should use 13151; those exceeding 7.6 cm must add 13153 for each additional 5 cm.
Impact: Accurate length documentation ensures proper code selection; 1mm difference at threshold determines $320-370 payment variance
Submit claims with non-facility POS code (11) when performed in office setting to receive $478.40 vs $324.44 facility rate. Verify place of service accurately reflects where procedure occurred.
Impact: Correct POS coding captures additional $153.96 in reimbursement for office-based procedures

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Related actions

Common denials

Medical necessity not established - payer downcodes to simple repair (12051-12057) stating documentation does not support complexity requirements

How to appeal: Submit operative report highlighting specific complexity elements: layered closure technique documented with suture type/size for each layer, contamination requiring debridement, undermining measurements, or tissue rearrangement. Reference CPT definition requiring one or more deeper layers. Include comparison to simple repair CPT descriptor showing why those criteria not met.

Bundled with Mohs surgery, excision, or other procedure performed same session - payer considers repair inclusive to primary procedure

How to appeal: Verify primary procedure code descriptor does not include intermediate or complex closure. Submit documentation showing repair distinctly separate (different site) or significantly exceeds work of simple closure that would be included. Append modifier 59 with detailed explanation of why repair is separately reportable. Reference NCCI edits showing 13152 is not bundled with the primary procedure code.

Length documentation insufficient - claim denied or downcoded to shorter length code (13151) due to unclear or missing wound measurement

How to appeal: Provide operative report with explicit pre-repair wound measurement showing length of 2.6-7.5 cm documented before closure. Include diagram if available. Explain that wound length is measured at greatest dimension after debridement but before closure. Calculate total length if multiple repairs in same category/location were combined per CPT guidelines.

Duplicate claim denial when multiple complex repairs billed separately rather than combined by anatomic grouping and complexity

How to appeal: If repairs were truly at distinct anatomic sites within the face/neck grouping, submit documentation with anatomic diagrams showing separate locations and append modifier 59. If repairs should have been combined, submit corrected claim with total combined length and withdraw duplicate. Reference CPT guidelines stating repairs in same classification and anatomic area should be added together.

Frequently asked questions

What is the Medicare reimbursement rate for CPT code 13152 in 2025?

The 2025 Medicare national average reimbursement for CPT 13152 is $478.40 for non-facility settings (office/clinic) and $324.44 for facility settings (hospital/ASC). Actual payment may vary by geographic locality based on GPCI adjustments.

What is the difference between CPT 13152 and simple repair codes?

CPT 13152 is for complex repairs requiring layered closure of deeper tissue layers plus skin, while simple repairs (12051-12057) involve single-layer closure of skin. Complex repairs require documentation of undermining, debridement, contamination, or multi-layer closure technique. The reimbursement difference is approximately $200-280, with 13152 paying significantly more due to increased work and time.

How many RVUs is CPT code 13152 worth?

CPT 13152 has 14.79 total RVUs for 2025, consisting of 5.34 work RVUs, 8.81 non-facility practice expense RVUs (4.05 facility PE RVUs), and 0.64 malpractice RVUs. This is a moderately high-value procedure code reflecting the technical complexity and time required.

Can CPT 13152 be billed with an office visit on the same day?

Yes, if the E/M service is significant and separately identifiable from the decision to perform the repair. Append modifier 25 to the E/M code. Document the separate evaluation that led to the decision for repair, distinct from the standard pre-procedure assessment. The repair itself does not support a separate E/M unless significant additional evaluation occurred.

What wound size qualifies for CPT 13152?

CPT 13152 requires wound length of 2.6 cm to 7.5 cm on the face, ears, eyelids, nose, lips, or mucous membranes. Wounds 2.5 cm or less use 13151, while wounds exceeding 7.5 cm require adding 13153 for each additional 5 cm or fraction thereof. Length is measured at the longest dimension after any debridement but before closure.

Can multiple complex facial repairs be billed separately?

Complex repairs in the same anatomic grouping (face/ears/eyelids/nose/lips) should be added together by total length and billed as one code. Only if repairs are at distinctly different anatomic areas or significantly separated sites might separate coding with modifier 59 be appropriate. Improper separate billing results in denial of secondary repairs.

What documentation proves a repair is complex versus simple?

Documentation must explicitly describe layered closure technique, specifying which tissue layers were closed separately (subcutaneous, fascia, dermis, skin) with suture details for each layer. Additional complexity indicators include measurements of undermining performed, extent of contamination requiring debridement, tissue rearrangement techniques, or use of retention sutures. Simply stating 'complex repair' without technical details is insufficient and risks downcoding.