Summary & Overview
CPT 12007: Simple Repair of Superficial Wounds Over 30.0 cm
CPT code 12007 is a nationally recognized billing code for the simple repair of superficial wounds exceeding 30.0 cm in length across various anatomical sites, including the scalp, neck, axillae, external genitalia, trunk, and extremities. This code is significant for healthcare providers and billing professionals as it captures a common outpatient procedure performed in hospital settings, ensuring accurate reimbursement and compliance with payer requirements.
Major payers such as Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare provide coverage for services billed under CPT code 12007. The publication offers a comprehensive overview of payer policies, clinical benchmarks, and recent updates relevant to this procedure. Readers will gain insights into the clinical context of wound repair, typical sites of service, and the importance of precise coding for large superficial wounds. The summary also highlights related codes and modifiers that may impact billing and reimbursement, providing a clear framework for understanding how this code fits within broader procedural and policy landscapes.
This article is designed for healthcare administrators, coding professionals, and policy analysts seeking up-to-date information on CPT code 12007, including payer coverage, clinical indications, and billing nuances. The content supports informed decision-making and compliance in medical billing and coding practices.
CPT Code Overview
CPT code 12007 describes the simple repair of superficial wounds of the scalp, neck, axillae, external genitalia, trunk, and/or extremities (including hands and feet) when the total wound length exceeds 30.0 cm. This procedure is classified under Repair–Simple Procedures on the Integumentary System and is typically performed in an outpatient hospital setting (Place of Service 22). The code is used to report wound repairs that do not require layered closure or complex techniques, focusing on straightforward closure of superficial injuries.
Clinical & Coding Specifications
Clinical Context
A patient presents to the outpatient hospital with multiple superficial lacerations across the scalp, neck, axillae, trunk, and extremities, such as hands and feet. The total length of the wounds requiring simple repair exceeds 30.0 cm. The clinical workflow involves assessment of the wounds, ensuring no foreign bodies are present, and performing a simple closure using sutures, staples, or adhesive strips. The procedure is performed by a provider specializing in surgery, family medicine, or dermatology. Documentation includes the total length of wounds repaired and the anatomical locations involved.
Coding Specifications
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Modifier
51(Multiple Procedures):- Used when more than one procedure is performed during the same session. Indicates that
12007is one of several procedures.
- Used when more than one procedure is performed during the same session. Indicates that
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Modifier
59(Distinct Procedural Service):- Used to identify procedures/services that are not normally reported together, but are appropriate under the circumstances. Indicates that
12007is distinct from other services provided.
- Used to identify procedures/services that are not normally reported together, but are appropriate under the circumstances. Indicates that
| Taxonomy Code | Specialty |
|---|---|
208600000X | Surgery Physician |
207Q00000X | Family Medicine Physician |
208D00000X | Dermatology Physician |
- These taxonomies represent providers who commonly perform simple wound repairs.
Related Diagnoses
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S01.81XA: Laceration without foreign body of other part of head, initial encounter- Relevant for wounds on the head that require simple repair.
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S51.811A: Laceration without foreign body of right forearm, initial encounter- Applies to superficial lacerations of the right forearm needing closure.
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S61.219A: Laceration without foreign body of unspecified finger without damage to nail, initial encounter- Used for finger lacerations without nail involvement, suitable for simple repair.
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S91.311A: Laceration without foreign body of right foot, initial encounter- Pertains to superficial lacerations of the right foot.
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T81.89XA: Other complications of procedures, not elsewhere classified, initial encounter- Used when complications arise during or after the repair procedure.
Related CPT Codes
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12006: simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 0 to 2.5 cm- Used for smaller wounds requiring simple repair. May be used in conjunction with
12007if multiple wounds of varying lengths are repaired.
- Used for smaller wounds requiring simple repair. May be used in conjunction with
-
12011: simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 30.1 cm to 60.0 cm- Used for wounds with a total length between 30.1 cm and 60.0 cm. May be an alternative to
12007depending on wound length.
- Used for wounds with a total length between 30.1 cm and 60.0 cm. May be an alternative to
-
These codes are related by wound length and anatomical site. They are commonly used together when multiple wounds of different sizes are repaired in a single session.
National Reimbursement Benchmarks
For CPT code 12007, the national mean rate for Medicare is $262.28, closely aligned with the BUCA (Blue Cross Blue Shield, UnitedHealth Group, Cigna, and Aetna) average commercial mean rate of $265.01. Commercial payers such as UnitedHealth Group and Cigna report higher mean rates, at $354.51 and $326.20 respectively, while Aetna is notably lower at $167.34.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. Medicare exhibits the tightest range ($26.00), indicating more consistent reimbursement rates. In contrast, UnitedHealth Group shows the widest dispersion ($198.33), reflecting greater variability in commercial rates. Blue Cross Blue Shield and Cigna also display substantial ranges, at $120.83 and $172.00 respectively.
The table and chart below present a detailed breakdown of national benchmarks for each payer, including mean rates and percentile values.
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