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CPT 12013 Fee Schedule

Last Verified: January 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.

Rep Simple Face Adnexa 2.5-5 Cm
Key FactDetail
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 LevelLow

National average reimbursement for CPT 12013 by major payers:

bcbs

$146.91

uhc

$164.68

aetna

$170.22

cigna

$199.48

Preview provider-level rates for...
For billing codeCPT 12013
PayerCodeRateNPITax IDStateSpecialty

Select a payer to view fee schedule data

Choose a payer from the options above to see rates for CPT 12013

United
12013$191.001689910739 - THE ENDOSCOPY CENTER AT BAINBRIDGE, LLC, UNIVERSITY SUBURBAN ENDOSCOPY CENTER205430025 - (OH) THE ENDOSCOPY CENTER AT BAINBRIDGE LLCOHAmbulatory Surgical Clinic/Center (261QA1903X)
United
12013$159.001447442348 - TIMOTHY P. CAREY M.D. INC. P.S.910870414 - (WA) TIMOTHY P CAREY MD INC PSWAAmbulatory Surgical Clinic/Center (261QA1903X)
United
12013$935.001881678662 - SURGERY AFFILIATE OF EL PASO, LLC, FOUNDATION SURGERY AFFILIATE OF EL PASO, LLC742797719 - (TX) SURGERY AFFILIATE OF EL PASO LLCTXAmbulatory Surgical Clinic/Center (261QA1903X)
United
12013$175.001508574518 - AMBULATORY SURGERY CENTER OF CENTRALIA883961418ILAmbulatory Surgical Clinic/Center (261QA1903X)
United
12013$1543.001669701157 - GLASTONBURY SURGERY CENTER, LLC262600828 - (CT) GLASTONBURY SURGERY CENTER, LLCCTAmbulatory Surgical Clinic/Center (261QA1903X)
United
12013$728.001023218500 - SAN MARTIN SURGERY CENTER LLC202999408 - (NV) SAN MARTIN SURGERY CENTER LLCNVAmbulatory Surgical Clinic/Center (261QA1903X)
United
12013$906.001710940218 - DENVER MID-TOWN SURGERY CENTER LTD752548180 - DENVER MIDTOWN SURGERY CENTER LTDCOAmbulatory Surgical Clinic/Center (261QA1903X)
United
12013$87.001164469086 - SAME DAY SURGICARE OF NEW ENGLAND, INC., SAME DAY SURGICLINIC42808359 - (MA) SAME DAY SURGICARE OF NEW ENGLAND, INC.MAAmbulatory Surgical Clinic/Center (261QA1903X)
United
12013$87.001982978466 - NORTHWEST ENT SURGERY CENTER, LLC453307193 - (GA) NORTHWEST ENT SURGERY CENTER LLCGAAmbulatory Surgical Clinic/Center (261QA1903X)
United
12013$77.001053417402 - KEYSTONE KIDNEY ASSOCIATES, PC232470181 - (PA) KEYSTONE KIDNEY ASSOCIATES PCPAAmbulatory Surgical Clinic/Center (261QA1903X)
United
12013$555.001154956928 - ADVANCED SURGICAL CARE OF CLEARWATER LLC833698204 - (FL) ADVANCED SURGICAL CARE OF CLEARWATER LLCFLAmbulatory Surgical Clinic/Center (261QA1903X)
United
12013$935.001558401299 - SAN GABRIEL VALLEY SURGICAL CENTER LP752965449 - (CA) SAN GABRIEL VALLEY SURGICAL CENTER LPCAAmbulatory Surgical Clinic/Center (261QA1903X)
United
12013$185.001831846369 - OPHTHALMIC SURGERY CENTER, LLC874648478 - (KY) OPHTHALMIC SURGERY CENTER LLCKYAmbulatory Surgical Clinic/Center (261QA1903X)
United
12013$531.001245711803 - SURGCENTER CLEARWATER, LLC, SURGCENTER DUNEDIN823682684 - (FL) SURGCENTER CLEARWATER LLCFLAmbulatory Surgical Clinic/Center (261QA1903X)
United
12013$555.001033373691 - THE SOUTHEASTERN SPINE INSTITUTE AMBULATORY SURGERY CENTER, LLC208037589 - (SC) THE SOUTHEASTERN SPINE INSTITUTE AMBULATORY SURGERY CENTER LLCSCAmbulatory Surgical Clinic/Center (261QA1903X)
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist

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CPT 12013 vs. Other Surgical Procedures on the Integumentary System Codes

The CPT 12013 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 12013 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.

CodeComplexityDescription
12011-CPTLowSimp Rpr Face Ear Etc To 2.5 Cm
12013-CPTLowRep Simple Face Adnexa 2.5-5 Cm
12014-CPTLowSimp Rpr Face Ear Etc 5.1-7.5 Cm
12015-CPTModerateRep Simple Face Adnexa 7.5-12.5cm

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 12013. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 12013 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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