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See a sample rate comparisonCPT 13100 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.
Clean And Stitch Wound, Cleaning And Removal Of Damaged Or Infected Tissue For A Wound On The Upper Body. The Wound Is Stitched Closed.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Integumentary System |
| Common Place of Service | 11 - Office 81 - Independent Laboratory |
| Common Modifiers | None 59 - Distinct Procedural Service QW - CLIA Waived Tests |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 13100 |
| Medicaid Fee Schedule | View Medicaid rates for 13100 |
National average reimbursement for CPT 13100 by major payers:
$371.60
$417.00
$424.02
$533.87
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CPT 13100
5 of 25 sample ratesHigher to lower in this preview
Garland Surgicare Partners, Ltd., Baylor Surgicare At Garland
Garland Surgicare Partners Ltd
$1,446.00Published rateRoosevelt Surgery Center, LLC
$879.00Published rateHealthcare Enterprises LLC, The Surgery Center
Healthcare Enterprises LLC
$500.00Published rateThe Vancouver Clinic Inc Ps, Salmon Creek 2 Ambulatory Surgery Center
The Vancouver Clinic, Inc., Ps
$241.00Published rateJohn P Lydon Dpm, Bethesda Ambulatory Surgical Center
John P Lydon, Dpm
$37.00Published rate
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See a sample payer proposalCPT 13100 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 13100 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 13100 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 |
|---|---|---|
| 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. |
| 13100-CPT | Moderate | Clean And Stitch Wound, Cleaning And Removal Of Damaged Or Infected Tissue For A Wound On The Upper Body. The Wound Is Stitched Closed. |
| 13101-CPT | Moderate | Clean And Stitch Wound, Cleaning And Removal Of Damaged Or Infected Tissue For A Wound On The Upper Body. The Wound Is Stitched Closed. |
| 13102-CPT | Low | Repair Complex Trunk Each A, Repair Complex Trunk Each Additional 5 Cm Or Less (List Separately In Addition To Code For Primary Procedure) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 13100. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 13100 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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