CPT 12001 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Surgery • Surgical Procedures on the Integumentary System |
| Common Place of Service | • 23 - Emergency Room • 20 - Urgent Care Facility |
| Common Modifiers | • None • 59 - Distinct Procedural Service • AG - Primary physician |
| Complexity Level | Moderate |
National average reimbursement for CPT 12001 by major payers:
$117.23
$132.25
$134.10
$159.97
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 12001 | ||||||
United | 12001 | $108.36 | 1710076427 - MITCHELL MANDEL | 881528980 - (CO) MANDEL DERMATOLOGY BOULDER PLLC | NY | Dermatology Physician (207N00000X) |
United | 12001 | $85.08 | 1831101757 - ANJALI SHAH | 452526738 - (NY) HUDSON VISTA MEDICAL PC | NY | Family Medicine Physician (207Q00000X) |
United | 12001 | $110.73 | 1932747391 - FATMA AL BAYITEE | 237221763 - THE UNITY HOSPITAL OF ROCHESTER | NY | Family Medicine Physician (207Q00000X) |
United | 12001 | $87.38 | 1336397488 - JENNIFER MCKENNA | 205842775 | NY | Internal Medicine Physician (207R00000X) |
United | 12001 | $109.47 | 1003851064 - MOSTAQUE AHMED | 113237480 - (NY) URBAN STRATEGIES-BROOKDALE FAMILY CARE CENTER INC | NY | Internal Medicine Physician (207R00000X) |
United | 12001 | $54.11 | 1033274147 - NEW YORK ALLERGY & SINUS GROUP, PLLC | 134173453 - (NY) NEW YORK ALLERGY SINUS GROUP PLLC | NY | Allergy & Immunology Physician (207K00000X) |
United | 12001 | $54.11 | 1003084138 - ANGELA LEO | 134151869 - (NY) SHERWIN K PARIKH MD PC | NY | Dermatology Physician (207N00000X) |
United | 12001 | $150.75 | 1093245037 - VLADIMIR FRIDKIN | 161012691 - CANTON-POTSDAM HOSPITAL | NY | Dermatology Physician (207N00000X) |
United | 12001 | $66.40 | 1942382353 - PAUL DANTZIG | 134155779 | NY | Dermatology Physician (207N00000X) |
United | 12001 | $162.57 | 1801317615 - REBECCA MILLER | 132655001 - NEW YORK CITY HEALTH AND HOSPITALS CORPORATION | NY | Pediatrics Physician (208000000X) |
United | 12001 | $179.46 | 1649220740 - STACEY WHYTE-CONNELL | 133843560 - CRYSTAL RUN HEALTHCARE PHYSICIANS, LLP | NY | Family Medicine Physician (207Q00000X) |
United | 12001 | $235.16 | 1205800703 - JAMES OCONNOR | 453023019 - (NY) NORTH SHORE-LIJ MEDICAL PC | NY | Internal Medicine Physician (207R00000X) |
United | 12001 | $111.44 | 1861021529 - CLARE WYNNE | 132707945 - (NY) BRONXCARE DR MARTIN LUTHER KING JR HEALTH CENTER | NY | Pediatrics Physician (208000000X) |
United | 12001 | $126.93 | 1255492245 - NELLY BOGGIO | 611661781 | NY | Pediatrics Physician (208000000X) |
United | 12001 | $138.77 | 1982769857 - WOOSUP KIM | 113386248 - (NY) WOO SUP KIM M D P C | NY | Internal Medicine Physician (207R00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 12001 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 12001 code is part of the Surgery services used for Surgical Procedures on the Integumentary System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 12001 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 12001 | Low | Simple Repair Of Superficial Wounds Of Scalp, Neck, Axillae, External Genitalia, Trunk And/Or Extremities (Including Hands And Feet); 2.5 Cm Or Less |
| 12002 | Low | Simple Repair Of Superficial Wounds Of Scalp, Neck, Axillae, External Genitalia, Trunk And/Or Extremities (Including Hands And Feet); 2.6 Cm To 7.5 Cm |
| 12004 | Low | Simple Repair Of Superficial Wounds Of Scalp, Neck, Axillae, External Genitalia, Trunk And/Or Extremities (Including Hands And Feet); 7.6 Cm To 12.5 Cm |
| 12020 | Moderate | Closure Superfic Wound Dehiscence |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 12001. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 12001 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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