Summary & Overview
CPT 12017: Simple Repair of Superficial Facial Wounds, 20.1–30.0 cm
CPT code 12017 is a nationally recognized billing code for the simple repair of superficial wounds of the face, ears, eyelids, nose, lips, and mucous membranes, specifically for wound lengths between 20.1 cm and 30.0 cm. This surgical procedure is commonly performed in office settings and is relevant for a wide range of clinical specialties, including surgery, family medicine, and dermatology. The code is essential for accurate billing and reimbursement, as it distinguishes between different wound lengths and repair complexities.
Major payers covering this code include Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare. The publication provides an overview of payer coverage, clinical context, and related coding benchmarks. Readers will gain insights into policy updates, coding practices, and the clinical scenarios in which CPT 12017 is utilized. The summary also highlights associated modifiers and taxonomies, as well as related CPT codes for different wound lengths. This information is valuable for understanding national trends in wound repair billing and ensuring compliance with payer requirements.
CPT Code Overview
CPT 12017 describes the simple repair of superficial wounds measuring 20.1 cm to 30.0 cm on the face, ears, eyelids, nose, lips, and/or mucous membranes. This procedure is classified as a surgical service and is typically performed in an office setting (Place of Service 11). The code is used when wounds require closure but do not involve deeper structures or complex repair techniques. Accurate coding ensures proper documentation and reimbursement for these common wound repairs in outpatient clinical practice.
Clinical & Coding Specifications
Clinical Context
A patient presents to the office with multiple superficial lacerations to the face, ears, eyelids, nose, lips, or mucous membranes. The total length of the wounds requiring repair is between 20.1 cm and 30.0 cm. The provider performs a simple repair, which involves cleaning the wounds, ensuring there is no foreign body, and closing the wounds with sutures or other appropriate materials. The procedure is performed in an office setting, and the patient is typically seen by a provider specializing in surgery, family medicine, or dermatology. Documentation includes the location, length, and type of wounds, as well as the technique used for repair.
Coding Specifications
-
Modifier
59: Used to indicate a distinct procedural service, such as when multiple repairs are performed at different anatomical sites or during separate encounters. -
Modifier
51: Used when multiple procedures are performed during the same session, allowing for proper sequencing and reimbursement.
| Modifier Code | Description |
|---|---|
59 | Distinct Procedural Service |
51 | Multiple Procedures |
- Provider Taxonomies:
| Taxonomy Code | Specialty |
|---|---|
208600000X | Surgery Physician |
207Q00000X | Family Medicine Physician |
208D00000X | Dermatology Physician |
Related Diagnoses
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S01.81XA: Laceration without foreign body of other part of head, initial encounter- Relevant for superficial lacerations of the head that require simple repair.
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S41.001A: Open wound of right shoulder, initial encounter- Indicates an open wound of the shoulder; may be relevant if the wound extends to the face or mucous membranes.
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S51.801A: Open wound of right forearm, initial encounter- Represents an open wound of the forearm; included if the repair involves contiguous areas.
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S61.401A: Unspecified open wound of right hand, initial encounter- Used for open wounds of the hand; may be relevant if the wound is near the face or mucous membranes.
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S71.001A: Unspecified open wound of right hip, initial encounter- Indicates an open wound of the hip; included for completeness if multiple wounds are present.
Related CPT Codes
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12016: Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes 12.6 cm‑20.0 cm- Used for repairs when the total wound length is between 12.6 cm and 20.0 cm. This code is an alternative to
12017when the wound length is less.
- Used for repairs when the total wound length is between 12.6 cm and 20.0 cm. This code is an alternative to
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12018: Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes >30.0 cm- Used for repairs when the total wound length exceeds 30.0 cm. This code is an alternative to
12017when the wound length is greater.
- Used for repairs when the total wound length exceeds 30.0 cm. This code is an alternative to
These codes are selected based on the total length of wounds repaired. Only one code is used per patient encounter, depending on the cumulative wound length. They are not typically used together but may be used as alternatives based on clinical findings.
National Reimbursement Benchmarks
For CPT code 12017, national mean rates show that Blue Cross Blue Shield, Cigna, UnitedHealth Group, and BUCA all reimburse at significantly higher levels than Medicare. The average commercial mean rate (BUCA) is $224.17, which is about 45% higher than the Medicare mean rate of $154.51.
Rate dispersion varies notably across payers. Medicare has the tightest range, with a difference of only $13.00 between its 75th and 25th percentiles, indicating minimal variation. In contrast, Cigna exhibits the widest spread, with a $162.00 difference between its 75th and 25th percentiles, reflecting substantial variability in commercial reimbursement. Blue Cross Blue Shield and UnitedHealth Group also show wide ranges, while Aetna is closer to Medicare in its dispersion.
The table and chart below present a detailed breakdown of national benchmarks for each payer, including mean rates and percentile values.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.