CPT 12005 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 • 21 - Inpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • AG - Primary physician |
| Complexity Level | Moderate |
National average reimbursement for CPT 12005 by major payers:
$216.15
$233.95
$237.30
$290.54
| 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 12005 | ||||||
United | 12005 | $383.00 | 1821276353 - PEND OREILLE SURGERY CENTER LLC | 300430739 - (ID) PEND OREILLE SURGERY CENTER LLC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12005 | $574.00 | 1043303894 - DOCTORS OUTPATIENT SURGERY CENTER OF JUPITER, LLC, LASER & SURGERY CENTER OF THE PALM BEACHES | 650953183 - (FL) DRS. OUTPATIENT SURGERY CENTER OF JUPITER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12005 | $935.00 | 1386657047 - THEDA OAKS GASTROENTEROLOGY & ENDOSCOPY CENTER, LLC | 20594510 - (TX) THEDA OAKS GASTROENTEROLOGY & ENDOSCOPY CTR, LTD | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12005 | $300.00 | 1083169700 - FOUR PEAKS SURGERY CENTER, LLC | 813258200 - (AZ) FOUR PEAKS SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12005 | $935.00 | 1417409285 - BEAUMONT ASC, LP, BEAUMONT HEART & VASCULAR SURGERY CENTER | 814050976 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12005 | $500.00 | 1073081501 - MILFORD-FRANKLIN EYE CENTER, LLC | 43287594 - (MA) MILFORD-FRANKLIN EYE CENTER, LLC | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12005 | $91.00 | 1316375884 - OXON HILL UROLOGY SURGERY CENTER PC | 463746777 - (MD) OXON HILL UROLOGY SURGERY CENTER PC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12005 | $168.00 | 1861418378 - MAPLEWOOD AMBULATORY SURGERY CENTER, INC. | 752730666 - (TX) MAPLEWOOD AMBULATORY SURGERY CENTER INC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12005 | $515.00 | 1710945787 - UPLAND OUTPATIENT SURGERY CENTER LP, ONTARIO ADVANCED SURGERY CENTER | 330812827 - (CA) UPLAND OUTPATIENT SURGERY CENTER LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12005 | $1029.00 | 1720020472 - DENTON SURGERY CENTER LLC, TEXAS HEALTH SURGERY CENTER DENTON | 470926556 - (TX) DENTON SURGERY CENTER, LLC DBA TEXAS HEALTH SURGERY CENTER DENTON | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12005 | $127.00 | 1619643608 - CARDIOVASCULAR ASC LLC | 462883732 - (FL) CARDIOVASCULAR ASC LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12005 | $935.00 | 1588709489 - FOOTHILL GATEWAY SURGERY CENTER LLC | 200604832 - (CA) FOOTHILL GATEWAY SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12005 | $528.00 | 1942883764 - MCLEAN TYSONS ORTHOPEDIC SURGERY CENTER, LLC | 851995349 - (VA) MCLEAN TYSONS ORTHOPEDIC SURGERY CENTER, LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12005 | $65.00 | 1619284536 - CHILDRENS SURGERY CENTER, LLC | 273074039 - (PA) CHILDRENS SURGERY CENTER, LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12005 | $566.00 | 1629386784 - ODESSA ENDOSCOPY CENTER LLC | 273305505 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
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 12005 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 12005 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 12005 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 |
|---|---|---|
| 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 |
| 12005 | Moderate | Simple Repair Of Superficial Wounds Of Scalp, Neck, Axillae, External Genitalia, Trunk And/Or Extremities (Including Hands And Feet); 12.6 Cm To 20.0 Cm |
| 12006 | Moderate | Simple Repair Of Superficial Wounds Of Scalp, Neck, Axillae, External Genitalia, Trunk And/Or Extremities (Including Hands And Feet); 20.1 Cm To 30.0 Cm |
| 12007 | Moderate | Simple Repair Of Superficial Wounds Of Scalp, Neck, Axillae, External Genitalia, Trunk And/Or Extremities (Including Hands And Feet); Over 30.0 Cm |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 12005. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 12005 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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