| Code | Description | States | Median rate |
|---|---|---|---|
| 12001 | Simple wound repair, scalp/trunk/limbs, 2.5 cm or less | 48 | $86.58 |
| 12002 | Simple wound repair, scalp/trunk/limbs, 2.6-7.5 cm | 48 | $104.20 |
| 12004 | Simple wound repair, scalp/trunk/limbs, 7.6-12.5 cm | 48 | $120.59 |
| 12005 | Simple wound repair, scalp/trunk/limbs, 12.6-20 cm | 48 | $160.52 |
| 12006 | Simple wound repair, body or limb, 20.1 to 30.0 cm | 48 | $186.47 |
| 12007 | Simple wound repair, body or limb, over 30.0 cm | 48 | $208.25 |
| 12011 | Simple wound repair, face/ears/lips, 2.5 cm or less | 48 | $103.32 |
| 12013 | Simple wound repair, face/ears/lips, 2.6-5 cm | 48 | $107.73 |
| 12014 | Simple wound repair, face or lips, 5.1 to 7.5 cm | 48 | $129.25 |
| 12015 | Simple wound repair, face or lips, 7.6 to 12.5 cm | 48 | $156.69 |
| 12016 | Simple wound repair, face or lips, 12.6 to 20.0 cm | 48 | $198.99 |
| 12017 | Simple wound repair, face or lips, 20.1 to 30.0 cm | 48 | $148.86 |
| 12018 | Simple wound repair, face or lips, over 30.0 cm | 48 | $172.12 |
| 12020 | Re-closure of a separated wound, simple | 46 | $221.63 |
| 12021 | Separated wound treatment with packing | 45 | $136.68 |
| 12031 | Intermediate wound repair, scalp/trunk/limbs, 2.5 cm or less | 48 | $183.46 |
| 12032 | Intermediate wound repair, scalp/trunk/limbs, 2.6-7.5 cm | 48 | $229.70 |
| 12034 | Intermediate wound repair, scalp or limb, 7.6 to 12.5 cm | 48 | $225.72 |
| 12035 | Intermediate wound repair, scalp or limb, 12.6 to 20.0 cm | 48 | $293.12 |
| 12036 | Intermediate wound repair, scalp or limb, 20.1 to 30.0 cm | 48 | $332.94 |
| 12037 | Intermediate wound repair, scalp or limb, over 30.0 cm | 48 | $371.35 |
| 12041 | Intermediate wound repair, neck/hands/feet, 2.5 cm or less | 48 | $177.26 |
| 12042 | Intermediate wound repair, neck/hands/feet, 2.6-7.5 cm | 48 | $206.22 |
| 12044 | Intermediate wound repair, neck, hand or foot, 7.6-12.5 cm | 48 | $260.84 |
| 12045 | Intermediate wound repair, neck, hand or foot, 12.6-20 cm | 48 | $321.09 |
| 12046 | Intermediate wound repair, neck, hand or foot, 20.1-30 cm | 48 | $371.20 |
| 12047 | Intermediate wound repair, neck, hand or foot, over 30 cm | 48 | $418.22 |
| 12051 | Intermediate wound repair, face/ears/lips, 2.5 cm or less | 48 | $195.28 |
| 12052 | Intermediate wound repair, face or lips, 2.6 to 5.0 cm | 48 | $212.74 |
| 12053 | Intermediate wound repair, face or lips, 5.1 to 7.5 cm | 48 | $243.66 |
| 12054 | Intermediate wound repair, face or lips, 7.6 to 12.5 cm | 48 | $266.76 |
| 12055 | Intermediate wound repair, face or lips, 12.6 to 20.0 cm | 48 | $367.38 |
| 12056 | Intermediate wound repair, face or lips, 20.1 to 30.0 cm | 48 | $439.34 |
| 12057 | Intermediate wound repair, face or lips, over 30.0 cm | 48 | $450.84 |
Published Medicaid fee-for-service schedule amounts, not a coverage or eligibility guarantee. Managed-care plan rates can differ. Where no prior-authorization flag is shown, the state does not publish one. Descriptions are ProviderSignal's own plain-language labels or public-domain CMS text.