CPT 12007 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 | Repair-Simple Procedures on the Integumentary System Surgical Repair (Closure) 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 |
| Medicare Fee Schedule | View Medicare rates for 12007 |
National average reimbursement for CPT 12007 by major payers:
$294.28
$321.13
$316.32
$390.17
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 12007 | $349.00 | 1386858595 - ALDERWOOD SURGERY CENTER LLC | 204979154 - (WA) ALDERWOOD SURGICAL CENTER | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12007 | $586.00 | 1518634732 - MEDSTAR HEALTH ENDOSCOPY CENTER | 872341245 - (MD) MEDSTAR HEALTH ENDOSCOPY CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12007 | $79.00 | 1265770572 - PHILADELPHIA SURGERY CENTER, INC. | 454790325 - (PA) PHILADELPHIA SURGERY CENTER INC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12007 | $555.00 | 1154387710 - WARNER PARK SURGERY CENTER LLC, CENTER FOR ADVANCED SURGERY | 752824260 - (AZ) WARNER PARK SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12007 | $485.00 | 1720081870 - ORTHOPAEDIC AMBULATORY SURGICAL INTERVENTION SERVICES, LLC, OASIS | 582398485 - (OH) ORTHOPAEDIC AMBULATORY SURGICAL INTERVENTION SERVICES, LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12007 | $553.00 | 1699855213 - SANTA MONICA SURGICAL PARTNERS LLC, SURGERY CENTER OF THE PACIFIC | 870760381 - (CA) SANTA MONICA SURGICAL PARTNERS LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12007 | $728.00 | 1730277575 - BEDFORD AMBULATORY SURGICAL CENTER, LLC | 20519727 - (NH) BEDFORD AMBULATORY SURGICAL CENTER LLC | NH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12007 | $300.00 | 1275598302 - WAUWATOSA SURGERY CENTER, LLC | 363469839 - (WI) WAUWATOSA SURGERY CENTER LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12007 | $75.00 | 1811929300 - COASTAL DIGESTIVE CARE CENTER LLC | 20621976 - (CT) COASTAL DIGESTIVE CARE CENTER LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12007 | $912.00 | 1518323435 - SOUTHTOWNS SURGERY CENTER LLC | 464742028 - (NY) SOUTHTOWNS SURGERY CENTER LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12007 | $131.00 | 1548456478 - WILMINGTON ASC LLC, WILMINGTON HEALTH AMBULATORY SURGERY CENTER | 870883587 | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12007 | $76.00 | 1992970230 - PARK CENTER FOR PROCEDURES LLC | 200467903 - (FL) PARK CENTER FOR PROCEDURES LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12007 | $1029.00 | 1396700407 - ARLINGTON SURGERY CENTER, LLC, ARLINGTON SURGERY CENTER ASSOCIATES, LP | 752055800 - (TX) ARLINGTON SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12007 | $178.00 | 1518004696 - CENTURY CITY ENDOSCOPY, LLC | 954754975 - (CA) CENTURY CITY ENDOSCOPY LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 12007 | $1413.00 | 1497749436 - NEW JERSEY SURGERY CENTER LLC, NEW JERSEY SURGERY CENTER | 161666417 - (NJ) NEW JERSEY SURGERY CENTER LLC | NJ | 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 12007 vs. Other Surgical Repair (Closure) Procedures on the Integumentary System Codes
The CPT 12007 code is part of the Repair-Simple Procedures on the Integumentary System services used for Surgical Repair (Closure) 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 12007 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 |
|---|---|---|
| 12005-CPT | Moderate | Rpr S N A Gen Trk12 6 20 0cm, 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-CPT | Moderate | Rpr S N A Gen Trk20 1 30 0cm, 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-CPT | Moderate | Rpr S N Ax Gen Trnk 30 0 Cm, Simple Repair Of Superficial Wounds Of Scalp Neck Axillae External Genitalia Trunk And Or Extremities Including Hands And Feet Over 30 0 Cm |
| 12020-CPT | Moderate | Re-Close Surgical Opening, Procedure To Close A Surgical Cut That Has Opened Up. Techniques That May Be Used Include Stitching The Wound Or Inserting A Packing Material For Drainage. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 12007. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 12007 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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