How much does Medicare pay for CPT 12001?

Medicare allowed an average of $64.10 per service and paid $48.30 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $318.67, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 12001?

Simple repair of surface wound of scalp, neck, underarms, trunk, arms, or legs, 2.5 cm or less. It was billed 5,880 times to 5,349 Medicare beneficiaries by 353 providers in 2024.

Does 12001 pay differently in an office than a hospital?

Yes. The allowed amount averaged $81.58 in an office setting and $39.79 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 12001 most?

Emergency Medicine, with 1,116 services from 83 clinicians. Next are Physician Assistant, Nurse Practitioner, Family Practice.

CPT 12001

Simple repair of surface wound of scalp, neck, underarms, trunk, arms, or legs, 2.5 cm or less

$64.10Medicare-allowed amount per service, averaged across 5,880 services

Providers submitted

$318.67

Asking price, not received

Medicare allowed

$64.10

The fee schedule figure

Medicare paid

$48.30

Balance is patient coinsurance

Providers submitted an average of $318.67 for this code and Medicare allowed $64.10 — 5.0× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $48.30 (75%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $81.58
Hospital / facility: $39.79

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 3,421 services were billed in an office setting and 2,459 in a facility.

Services: 5,880
Beneficiaries: 5,349
Providers billing it: 353
Total allowed: $376,908

What Medicare pays for CPT 12001

Across 5,880 services billed by 353 providers to 5,349 beneficiaries, Medicare allowed an average of $64.10 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 12001

Specialty	Services	Beneficiaries	Avg allowed	Providers
Emergency Medicine	1,116	1,106	$62.23	83
Physician Assistant	1,114	1,111	$45.33	87
Nurse Practitioner	927	900	$53.55	58
Family Practice	736	705	$80.04	51
Dermatology	691	663	$45.51	29
Urology	422	173	$114.03	7
Podiatry	261	141	$81.37	7
Internal Medicine	223	205	$91.25	11
Micrographic Dermatologic Surgery	199	189	$52.56	10
General Surgery	91	58	$86.32	4
Hospitalist	42	42	$87.50	2
General Practice	25	25	$102.07	2
Plastic and Reconstructive Surgery	19	19	$111.64	1
Undersea and Hyperbaric Medicine	14	12	$44.19	1

12001 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	1,008	$90.20	$57.94	44
Florida	609	$58.93	$43.06	39
New Jersey	441	$61.52	$41.83	23
Maryland	356	$81.57	$55.25	21
Pennsylvania	315	$71.89	$50.52	21
Virginia	228	$55.83	$40.72	7
Massachusetts	224	$60.68	$42.91	15
New York	218	$71.37	$45.75	14
Texas	179	$47.10	$35.42	13
Arizona	163	$58.32	$46.16	11
Tennessee	155	$45.91	$37.38	10
Illinois	153	$58.27	$42.58	12
Michigan	147	$71.60	$51.67	11
Ohio	142	$48.98	$36.50	10
Georgia	136	$50.25	$37.42	9
Kentucky	132	$48.59	$37.69	6
Delaware	115	$81.61	$58.79	8
Connecticut	103	$52.29	$32.69	7
South Carolina	99	$50.99	$37.62	7
Wisconsin	95	$43.50	$35.58	4
Mississippi	84	$38.07	$27.85	7
Arkansas	72	$42.35	$34.95	5
Missouri	63	$36.07	$28.20	5
District of Columbia	61	$51.51	$34.82	2
Rhode Island	60	$101.93	$70.03	3
Iowa	48	$48.52	$35.88	4
Indiana	46	$39.61	$30.31	4
Kansas	44	$40.30	$35.10	2
North Carolina	44	$54.11	$42.53	4
Alabama	36	$57.20	$42.64	3
Nebraska	35	$37.79	$33.46	3
Washington	32	$45.07	$35.64	2
Utah	27	$39.18	$32.03	2
Oklahoma	26	$38.34	$29.05	2
Louisiana	23	$39.41	$29.13	2
New Mexico	20	$22.84	$17.46	1
Idaho	19	$43.52	$36.81	1
Colorado	18	$46.82	$37.02	1
South Dakota	17	$44.86	$37.01	1
Hawaii	17	$36.86	$27.93	1
North Dakota	14	$96.25	$71.38	1
New Hampshire	12	$38.56	$27.25	1
Oregon	11	$35.95	$28.20	1
Minnesota	11	$21.22	$17.44	1
Puerto Rico	11	$46.38	$34.81	1
Vermont	11	$41.29	$31.98	1

Related codes

12032Intermediate repair of wound of scalp$250.68
12052Intermediate repair of wound of face$174.94
12042Intermediate repair of wound of neck$198.63
12051Intermediate repair of wound of face$170.56
12031Intermediate repair of wound of scalp$221.43
12034Intermediate repair of wound of scalp$235.14
12053Intermediate repair of wound of face$180.85
12002Simple repair of surface wound of scalp$68.13
12041Intermediate repair of wound of neck$171.72
12011Simple repair of surface wound of face$58.25
12013Simple repair of surface wound of face$54.97

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.