How much does Medicare pay for CPT 12031?

Medicare allowed an average of $221.43 per service and paid $168.05 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $545.25, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 12031?

Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.5 cm or less. It was billed 25,967 times to 24,600 Medicare beneficiaries by 1,131 providers in 2024.

Does 12031 pay differently in an office than a hospital?

Yes. The allowed amount averaged $225.35 in an office setting and $117.26 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 12031 most?

Dermatology, with 17,278 services from 758 clinicians. Next are Physician Assistant, Micrographic Dermatologic Surgery, Plastic and Reconstructive Surgery.

CPT 12031

Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.5 cm or less

$221.43Medicare-allowed amount per service, averaged across 25,967 services

Providers submitted

$545.25

Asking price, not received

Medicare allowed

$221.43

The fee schedule figure

Medicare paid

$168.05

Balance is patient coinsurance

Providers submitted an average of $545.25 for this code and Medicare allowed $221.43 — 2.5× 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 $168.05 (76%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $225.35
Hospital / facility: $117.26

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. 25,025 services were billed in an office setting and 942 in a facility.

Services: 25,967
Beneficiaries: 24,600
Providers billing it: 1,131
Total allowed: $5,749,873

What Medicare pays for CPT 12031

Across 25,967 services billed by 1,131 providers to 24,600 beneficiaries, Medicare allowed an average of $221.43 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 12031

Specialty	Services	Beneficiaries	Avg allowed	Providers
Dermatology	17,278	16,426	$227.78	758
Physician Assistant	3,497	3,293	$211.71	156
Micrographic Dermatologic Surgery	1,419	1,385	$183.64	60
Plastic and Reconstructive Surgery	1,326	1,250	$216.02	50
Nurse Practitioner	809	760	$202.62	48
General Surgery	513	488	$209.33	26
Family Practice	374	331	$259.11	11
Internal Medicine	282	223	$244.35	6
Ambulatory Surgical Center	242	232	$154.68	7
Otolaryngology	86	80	$217.76	4
Orthopedic Surgery	85	78	$240.26	1
General Practice	16	15	$198.93	1
Surgical Oncology	14	14	$242.65	1
Pathology	13	13	$264.76	1
Cardiology	13	12	$238.42	1

12031 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	3,295	$250.42	$168.21	133
Florida	2,699	$226.15	$171.14	111
Texas	2,070	$219.54	$168.13	85
Maryland	1,367	$229.59	$159.39	47
Illinois	1,308	$217.31	$162.74	45
Georgia	1,161	$207.77	$162.24	48
Pennsylvania	1,128	$234.82	$179.59	53
Ohio	1,050	$220.16	$175.48	48
Virginia	870	$218.74	$162.18	35
Arizona	831	$217.19	$165.13	40
New York	804	$248.41	$172.17	36
Indiana	699	$175.85	$142.36	25
Massachusetts	692	$220.69	$154.07	37
New Jersey	657	$235.23	$162.43	26
South Carolina	531	$206.19	$166.13	24
Tennessee	526	$203.63	$164.87	28
North Carolina	502	$190.67	$149.45	23
Mississippi	424	$215.07	$181.49	17
Oregon	346	$239.84	$175.35	17
Oklahoma	332	$196.61	$155.63	19
Washington	318	$223.92	$159.71	16
Minnesota	312	$213.18	$152.38	14
Missouri	307	$217.77	$173.86	18
Kentucky	305	$207.99	$166.98	12
Louisiana	297	$209.73	$174.07	14
Iowa	295	$189.17	$152.45	13
Alabama	269	$190.07	$169.60	10
Wisconsin	269	$183.05	$144.42	18
Colorado	203	$227.81	$164.68	12
Michigan	196	$222.32	$162.57	12
Connecticut	191	$220.03	$149.77	6
West Virginia	188	$179.71	$153.70	9
Nebraska	153	$210.38	$166.07	8
Hawaii	147	$279.61	$186.74	6
Kansas	146	$195.99	$158.41	8
South Dakota	142	$214.33	$169.91	7
New Mexico	136	$161.51	$123.56	8
Utah	122	$175.57	$144.07	6
Wyoming	109	$227.05	$170.28	5
Arkansas	81	$196.05	$165.51	4
Idaho	81	$167.49	$134.74	4
New Hampshire	74	$202.64	$158.78	5
North Dakota	63	$183.95	$144.84	3
ZZ	56	$262.72	$203.59	1
Delaware	51	$246.97	$184.96	3
District of Columbia	46	$241.77	$170.29	3
Nevada	37	$192.58	$150.38	3
Alaska	29	$262.62	$190.24	2
Montana	24	$172.15	$110.74	2
Puerto Rico	17	$212.82	$170.00	1
Rhode Island	11	$230.11	$178.28	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
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
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.