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See a sample rate comparisonCPT 12011 Fee Schedule
Last Verified: October 2026
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.
Rpr F E E N L M 2 5 Cm, Simple Repair Of Superficial Wounds Of Face Ears Eyelids Nose Lips And Or Mucous Membranes 2 5 Cm Or Less
| 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 AG - Primary physician UA |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 12011 |
| Medicaid Fee Schedule | View Medicaid rates for 12011 |
National average reimbursement for CPT 12011 by major payers:
$140.76
$154.39
$159.98
$188.66
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CPT 12011
5 of 25 sample ratesHigher to lower in this preview
Scott & White Hospital, Baylor Scott & White Medical Center - Round Rock
Scott & White Hospital Round Rock
$2,866.00Published rateAscension Seton, Ascension Seton Northwest
Ascension Seton
$1,240.00Published rateAthens Hospital, LLC
$551.00Published rateBsa Hospital LLC
$149.25Published rateBsa Hospital LLC
$99.58Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 12011 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 12011 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 12011 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 |
|---|---|---|
| 12011-CPT | Low | Rpr F E E N L M 2 5 Cm, Simple Repair Of Superficial Wounds Of Face Ears Eyelids Nose Lips And Or Mucous Membranes 2 5 Cm Or Less |
| 12013-CPT | Low | Rpr F E E N L M 2 6 5 0 Cm, Simple Repair Of Superficial Wounds Of Face Ears Eyelids Nose Lips And Or Mucous Membranes 2 6 Cm To 5 0 Cm |
| 12014-CPT | Low | Rpr F E E N L M 5 1 7 5 Cm, Simple Repair Of Superficial Wounds Of Face Ears Eyelids Nose Lips And Or Mucous Membranes 5 1 Cm To 7 5 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 12011. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 12011 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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