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See a sample rate comparisonCPT 12031 Fee Schedule
Medicare rates as of October 2026
CPT 12031 is classified under Surgery, in the Surgical Procedures on the Integumentary System subgroup.
Intmd Rpr S A T Ext 2 5 Cm, Repair Intermediate Wounds Of Scalp Axillae Trunk And Or Extremities Excluding Hands And Feet 2 5 Cm Or Less
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Integumentary System |
| Common Place of Service | 11 - Office 23 - Emergency Room |
| Common Modifiers | 59 - Distinct Procedural Service 51 - Multiple procedures |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $259.86 national non-facility rate (2026) · View Medicare rates for 12031 |
| Medicaid Fee Schedule | $204.135 median of the 8 states in the free preview · View Medicaid rates for 12031 |
National average reimbursement for CPT 12031 by major payers:
$270.10
BCBS / Anthem
$303.97
UnitedHealthcare
$333.27
Aetna
$401.65
Cigna
Compare published rates across providers.
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CPT 12031
5 of 25 sample ratesHigher to lower in this preview
Olasunkanmi Oyetunde
Aspirus Stevens Point Hospital & Clinics Inc
$798.40Published rateNeeta Motiwala
$461.64Published rateSukhjender Goraya
$277.57Published rateMahnaz Tantawi
Saddle Brook Medical Center PA
$163.13Published rateLeslie Cauvin
Bc Medical Care LLC
$82.98Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 12031 vs. Other Surgical Procedures on the Integumentary System Codes
The table lists codes related to 12031. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| 12031-CPT | Moderate | Intmd Rpr S A T Ext 2 5 Cm, Repair Intermediate Wounds Of Scalp Axillae Trunk And Or Extremities Excluding Hands And Feet 2 5 Cm Or Less |
| 12032-CPT | Moderate | Intmd Rpr S A T Ext 2 6 7 5, Repair Intermediate Wounds Of Scalp Axillae Trunk And Or Extremities Excluding Hands And Feet 2 6 Cm To 7 5 Cm |
| 12034-CPT | Moderate | Intmd Rpr S Tr Ext 7 6 12 5, Repair Intermediate Wounds Of Scalp Axillae Trunk And Or Extremities Excluding Hands And Feet 7 6 Cm To 12 5 Cm |
| 12041-CPT | Moderate | Rpair Intermed Wounds Of Nck Hands Feet &/Or Xtrnal Geni, Repair Intermediate Wounds Of Neck Hands Feet And/Or External Geni |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 12031. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 12031 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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Frequently Asked Questions
CPT 12031 reports an intermediate repair of wounds of the scalp, axillae, trunk and/or extremities (excluding hands and feet), 2.5 cm or less. Intermediate repair means a layered closure of deeper tissue, or a single-layer closure of a heavily contaminated wound that needed extensive cleaning.
Lengths of intermediate repairs in the same anatomic group are added together. A total over 2.5 cm moves to 12032 and higher. Intermediate repair codes carry a 10-day global period under Medicare.
Medicare pays CPT 12031 under the Physician Fee Schedule. The non-facility rate applies when the service is done in an office and covers the practice's staff, supplies and equipment; the lower facility rate applies in a hospital or surgery center, which bills its own facility fee. Both are adjusted for the local cost of practice. Commercial payers negotiate their own rates, often as a percentage of Medicare, so the same code can pay very differently from one contract to the next.
This page lists the rates commercial payers have published for CPT 12031 in their Transparency in Coverage files, so you can compare payers and see where a contract falls. For government benchmarks, PayerPrice also has the Medicare fee schedule lookup and Medicaid fee schedules by state.