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See a sample rate comparisonCPT 12016 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 Fe E En L M 12 6 20 0 Cm, Simple Repair Of Superficial Wounds Of Face Ears Eyelids Nose Lips And Or Mucous Membranes 12 6 Cm To 20 0 Cm
| 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 |
| Medicare Fee Schedule | View Medicare rates for 12016 |
| Medicaid Fee Schedule | View Medicaid rates for 12016 |
National average reimbursement for CPT 12016 by major payers:
$273.12
$300.14
$298.74
$365.27
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CPT 12016
5 of 25 sample ratesHigher to lower in this preview
Texas Health Harris Methodist Hospital Fort Worth
Texas Health Harris Methodist Hospital Southwest Fort Worth
$1,187.00Published rateRoanoke Ambulatory Surgery Center, LLC, Roanoke Ambulatory Surgery Center
Roanoke Ambulatory Surgery
$371.00Published rateBelmont/Harlem Surgery Center, LLC
Belmont/Harlem Surgery Center
$300.00Published rateParkside Surgery Center, LLC
Parkside Surgery Center
$150.00Published rateFemi-Care Surgery Center, LLC
Femicare Surgery Center LLC
$53.00Published rate
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See a sample payer proposalCPT 12016 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 12016 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 12016 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 |
|---|---|---|
| 12015-CPT | Moderate | Rpr F E E N L M 7 6 12 5 Cm, Simple Repair Of Superficial Wounds Of Face Ears Eyelids Nose Lips And Or Mucous Membranes 7 6 Cm To 12 5 Cm |
| 12016-CPT | Moderate | Rpr Fe E En L M 12 6 20 0 Cm, Simple Repair Of Superficial Wounds Of Face Ears Eyelids Nose Lips And Or Mucous Membranes 12 6 Cm To 20 0 Cm |
| 12017-CPT | Moderate | Rpr Fe E En L M 20 1 30 0 Cm, Simple Repair Of Superficial Wounds Of Face Ears Eyelids Nose Lips And Or Mucous Membranes 20 1 Cm To 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 12016. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 12016 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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