How much does Medicare pay for CPT 12011?

Medicare allowed an average of $58.25 per service and paid $45.75 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $274.14, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 12011?

Simple repair of surface wound of face, ears, eyelids, nose, lips, or mouth, 2.5 cm or less. It was billed 2,444 times to 2,247 Medicare beneficiaries by 113 providers in 2024.

Does 12011 pay differently in an office than a hospital?

Yes. The allowed amount averaged $61.48 in an office setting and $50.33 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 12011 most?

Dermatology, with 735 services from 32 clinicians. Next are Oral Surgery (Dentist only), Physician Assistant, Micrographic Dermatologic Surgery.

CPT 12011

Simple repair of surface wound of face, ears, eyelids, nose, lips, or mouth, 2.5 cm or less

$58.25Medicare-allowed amount per service, averaged across 2,444 services

Providers submitted

$274.14

Asking price, not received

Medicare allowed

$58.25

The fee schedule figure

Medicare paid

$45.75

Balance is patient coinsurance

Providers submitted an average of $274.14 for this code and Medicare allowed $58.25 — 4.7× 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 $45.75 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $61.48
Hospital / facility: $50.33

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. 1,736 services were billed in an office setting and 708 in a facility.

Services: 2,444
Beneficiaries: 2,247
Providers billing it: 113
Total allowed: $142,363

What Medicare pays for CPT 12011

Across 2,444 services billed by 113 providers to 2,247 beneficiaries, Medicare allowed an average of $58.25 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 12011

Specialty	Services	Beneficiaries	Avg allowed	Providers
Dermatology	735	717	$54.98	32
Oral Surgery (Dentist only)	616	457	$61.25	14
Physician Assistant	271	271	$48.27	19
Micrographic Dermatologic Surgery	270	267	$55.81	12
Emergency Medicine	254	252	$56.04	21
Nurse Practitioner	142	142	$48.56	9
Plastic and Reconstructive Surgery	80	76	$117.84	2
Maxillofacial Surgery	51	42	$63.01	2
Internal Medicine	14	12	$122.89	1
General Surgery	11	11	$52.82	1

12011 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	744	$62.74	$44.58	22
Florida	218	$53.87	$39.40	13
Virginia	165	$54.06	$42.79	7
Massachusetts	110	$44.31	$32.27	7
New Jersey	105	$51.97	$36.48	6
Illinois	100	$58.37	$40.78	7
Tennessee	94	$49.34	$42.20	5
Connecticut	88	$111.07	$59.60	2
Ohio	75	$52.77	$43.88	4
Colorado	62	$57.27	$44.66	2
Texas	60	$55.22	$43.89	3
South Dakota	59	$53.06	$43.96	1
Arizona	59	$54.45	$43.79	3
Georgia	57	$51.76	$44.95	1
Maryland	56	$61.14	$43.22	4
Kansas	55	$51.15	$43.95	2
New York	50	$58.67	$37.44	3
Nevada	46	$54.76	$43.81	3
Michigan	41	$40.83	$32.26	3
Missouri	38	$53.23	$40.33	3
Alabama	29	$50.45	$43.96	2
Pennsylvania	29	$56.99	$41.75	2
District of Columbia	19	$62.98	$43.92	1
Washington	14	$62.95	$43.95	1
Hawaii	13	$43.64	$29.80	1
North Carolina	13	$47.56	$44.85	1
Indiana	12	$53.97	$44.04	1
Wisconsin	11	$61.65	$42.69	1
Mississippi	11	$52.25	$43.26	1
South Carolina	11	$59.69	$43.00	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
12001Simple repair of surface wound of scalp$64.10
12002Simple repair of surface wound of scalp$68.13
12041Intermediate repair of wound of neck$171.72
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.