How much does Medicare pay for CPT 12051?

Medicare allowed an average of $170.56 per service and paid $133.52 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $605.37, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 12051?

Intermediate repair of wound of face, ears, eyelids, nose, lips, or mouth, 2.5 cm or less. It was billed 28,455 times to 27,491 Medicare beneficiaries by 942 providers in 2024.

Does 12051 pay differently in an office than a hospital?

Yes. The allowed amount averaged $174.10 in an office setting and $120.16 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 12051 most?

Dermatology, with 20,310 services from 662 clinicians. Next are Micrographic Dermatologic Surgery, Plastic and Reconstructive Surgery, Ambulatory Surgical Center.

CPT 12051

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

$170.56Medicare-allowed amount per service, averaged across 28,455 services

Providers submitted

$605.37

Asking price, not received

Medicare allowed

$170.56

The fee schedule figure

Medicare paid

$133.52

Balance is patient coinsurance

Providers submitted an average of $605.37 for this code and Medicare allowed $170.56 — 3.5× 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 $133.52 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $174.10
Hospital / facility: $120.16

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. 26,590 services were billed in an office setting and 1,865 in a facility.

Services: 28,455
Beneficiaries: 27,491
Providers billing it: 942
Total allowed: $4,853,285

What Medicare pays for CPT 12051

Across 28,455 services billed by 942 providers to 27,491 beneficiaries, Medicare allowed an average of $170.56 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 12051

Specialty	Services	Beneficiaries	Avg allowed	Providers
Dermatology	20,310	19,669	$164.35	662
Micrographic Dermatologic Surgery	4,056	3,965	$149.72	117
Plastic and Reconstructive Surgery	2,163	2,038	$232.95	80
Ambulatory Surgical Center	469	445	$169.18	14
Physician Assistant	401	390	$223.09	20
Otolaryngology	398	374	$225.52	19
Internal Medicine	152	120	$264.89	5
Family Practice	144	132	$260.18	6
Nurse Practitioner	128	127	$217.19	7
General Surgery	114	114	$156.74	7
Undefined Physician type	75	74	$149.23	2
Ophthalmology	45	43	$244.89	3

12051 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	3,033	$171.33	$131.96	95
California	2,666	$199.07	$134.32	93
Texas	1,760	$159.58	$124.14	56
Ohio	1,185	$151.31	$120.61	37
Virginia	1,164	$167.48	$129.72	30
Georgia	1,141	$159.16	$130.91	23
Pennsylvania	1,133	$180.95	$144.14	48
Maryland	1,091	$195.60	$142.33	25
Arizona	1,059	$153.22	$121.82	29
Illinois	949	$177.01	$135.31	29
Massachusetts	939	$161.72	$116.90	33
New York	775	$186.26	$135.02	31
Oregon	766	$184.65	$141.82	20
North Carolina	662	$156.70	$128.39	28
Indiana	649	$141.77	$119.73	15
Missouri	558	$160.27	$134.57	18
Tennessee	552	$168.70	$144.35	22
Iowa	524	$138.73	$117.79	17
Minnesota	518	$147.29	$116.44	18
Connecticut	513	$186.52	$128.63	13
Mississippi	505	$200.61	$170.94	14
New Jersey	496	$171.04	$123.21	18
Louisiana	464	$189.85	$160.61	16
South Carolina	453	$173.05	$140.97	22
Colorado	451	$175.23	$130.17	20
Kansas	435	$140.33	$119.36	11
Michigan	372	$173.97	$134.85	16
Washington	365	$189.99	$129.59	15
Utah	325	$141.58	$114.26	11
Alabama	271	$161.55	$147.78	9
Oklahoma	260	$146.30	$118.30	10
South Dakota	207	$167.88	$135.59	6
Kentucky	206	$159.03	$134.61	6
Idaho	202	$156.37	$131.37	8
New Mexico	199	$149.50	$120.36	6
Wisconsin	192	$152.84	$126.56	10
Nebraska	186	$168.56	$141.85	9
Arkansas	180	$152.96	$127.48	11
Wyoming	178	$226.37	$172.67	4
West Virginia	157	$156.24	$116.63	6
Montana	140	$158.39	$120.91	7
New Hampshire	113	$160.79	$123.49	5
Hawaii	81	$237.93	$169.84	3
Nevada	78	$171.82	$121.18	4
Maine	65	$144.26	$118.66	2
North Dakota	56	$146.11	$112.31	3
Vermont	48	$105.72	$82.13	3
Rhode Island	47	$184.15	$137.92	3
Puerto Rico	33	$147.96	$117.39	1
District of Columbia	20	$314.61	$195.42	1
Alaska	18	$159.17	$112.75	1
Delaware	15	$139.02	$111.30	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
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.