How much does Medicare pay for CPT 12042?

Medicare allowed an average of $198.63 per service and paid $155.33 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $655.34, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 12042?

Intermediate repair of wound of neck, hands, feet, or genitals, 2.6-7.5 cm. It was billed 41,061 times to 39,390 Medicare beneficiaries by 1,591 providers in 2024.

Does 12042 pay differently in an office than a hospital?

Yes. The allowed amount averaged $203.28 in an office setting and $120.35 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 12042 most?

Dermatology, with 32,046 services from 1,256 clinicians. Next are Micrographic Dermatologic Surgery, Physician Assistant, Plastic and Reconstructive Surgery.

CPT 12042

Intermediate repair of wound of neck, hands, feet, or genitals, 2.6-7.5 cm

$198.63Medicare-allowed amount per service, averaged across 41,061 services

Providers submitted

$655.34

Asking price, not received

Medicare allowed

$198.63

The fee schedule figure

Medicare paid

$155.33

Balance is patient coinsurance

Providers submitted an average of $655.34 for this code and Medicare allowed $198.63 — 3.3× 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 $155.33 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $203.28
Hospital / facility: $120.35

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. 38,758 services were billed in an office setting and 2,303 in a facility.

Services: 41,061
Beneficiaries: 39,390
Providers billing it: 1,591
Total allowed: $8,155,946

What Medicare pays for CPT 12042

Across 41,061 services billed by 1,591 providers to 39,390 beneficiaries, Medicare allowed an average of $198.63 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 12042

Specialty	Services	Beneficiaries	Avg allowed	Providers
Dermatology	32,046	30,674	$202.33	1,256
Micrographic Dermatologic Surgery	5,898	5,709	$163.68	187
Physician Assistant	1,178	1,145	$240.67	58
Plastic and Reconstructive Surgery	748	721	$242.33	36
Ambulatory Surgical Center	445	428	$159.38	18
Nurse Practitioner	143	140	$245.30	9
Undefined Physician type	142	137	$158.64	5
Family Practice	136	133	$270.24	5
General Surgery	129	126	$226.59	7
Otolaryngology	98	90	$224.81	5
Podiatry	61	50	$257.59	2
Internal Medicine	25	25	$255.53	2
Interventional Pain Management	12	12	$283.49	1

12042 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
Florida	4,147	$210.67	$160.95	154
Texas	3,222	$212.28	$165.72	131
California	2,542	$234.67	$159.92	109
Virginia	2,029	$201.25	$150.64	57
North Carolina	2,025	$199.88	$163.25	71
Pennsylvania	1,619	$184.40	$145.44	64
Georgia	1,593	$198.83	$162.56	57
Arizona	1,502	$198.18	$155.22	55
South Carolina	1,403	$222.52	$182.39	50
Ohio	1,348	$184.10	$147.73	61
Massachusetts	1,291	$199.57	$142.69	45
Illinois	1,208	$199.74	$151.10	45
Tennessee	1,119	$172.83	$147.37	46
Maryland	1,099	$226.92	$162.52	38
Missouri	886	$180.32	$146.49	34
New York	828	$184.76	$131.86	34
Washington	813	$203.21	$144.79	29
Alabama	777	$197.68	$168.45	28
Kansas	774	$200.24	$166.21	20
Wisconsin	677	$157.62	$128.06	33
Louisiana	642	$196.40	$165.44	24
Minnesota	635	$159.50	$126.32	31
Iowa	633	$175.41	$148.21	23
Colorado	604	$198.74	$148.89	28
Indiana	580	$160.74	$135.73	23
Michigan	554	$207.43	$159.87	24
Oklahoma	531	$193.84	$160.08	27
Arkansas	522	$161.27	$142.21	17
Kentucky	511	$165.53	$141.72	21
New Jersey	454	$216.49	$151.90	19
Mississippi	454	$208.85	$181.71	16
Connecticut	445	$192.27	$138.08	16
Oregon	375	$221.19	$171.86	19
Idaho	347	$179.98	$151.28	20
Nebraska	345	$228.96	$188.02	15
New Hampshire	331	$136.73	$105.41	11
Utah	303	$171.73	$139.97	16
Montana	277	$178.80	$138.42	11
Wyoming	235	$203.87	$156.74	7
West Virginia	231	$155.64	$133.43	8
New Mexico	202	$167.14	$133.38	8
Nevada	179	$209.31	$154.14	10
Delaware	155	$209.19	$158.21	8
Maine	111	$176.87	$138.56	5
Rhode Island	99	$177.05	$136.16	4
North Dakota	91	$94.68	$78.09	2
Vermont	88	$134.01	$101.80	6
South Dakota	85	$164.19	$143.81	5
Alaska	59	$226.18	$158.65	2
Hawaii	57	$211.66	$150.95	3
District of Columbia	24	$328.17	$240.72	1

Related codes

12032Intermediate repair of wound of scalp$250.68
12052Intermediate repair of wound of face$174.94
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
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.