How much does Medicare pay for CPT 12052?

Medicare allowed an average of $174.94 per service and paid $137.77 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $684.10, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 12052?

Intermediate repair of wound of face, ears, eyelids, nose, lips, or mouth, 2.6-5.0 cm. It was billed 79,769 times to 75,570 Medicare beneficiaries by 1,724 providers in 2024.

Does 12052 pay differently in an office than a hospital?

Yes. The allowed amount averaged $179.43 in an office setting and $120.88 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 12052 most?

Dermatology, with 61,290 services from 1,335 clinicians. Next are Micrographic Dermatologic Surgery, Plastic and Reconstructive Surgery, Physician Assistant.

CPT 12052

Intermediate repair of wound of face, ears, eyelids, nose, lips, or mouth, 2.6-5.0 cm

$174.94Medicare-allowed amount per service, averaged across 79,769 services

Providers submitted

$684.10

Asking price, not received

Medicare allowed

$174.94

The fee schedule figure

Medicare paid

$137.77

Balance is patient coinsurance

Providers submitted an average of $684.10 for this code and Medicare allowed $174.94 — 3.9× 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 $137.77 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $179.43
Hospital / facility: $120.88

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. 73,660 services were billed in an office setting and 6,109 in a facility.

Services: 79,769
Beneficiaries: 75,570
Providers billing it: 1,724
Total allowed: $13,954,789

What Medicare pays for CPT 12052

Across 79,769 services billed by 1,724 providers to 75,570 beneficiaries, Medicare allowed an average of $174.94 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 12052

Specialty	Services	Beneficiaries	Avg allowed	Providers
Dermatology	61,290	57,995	$176.21	1,335
Micrographic Dermatologic Surgery	12,851	12,273	$151.43	206
Plastic and Reconstructive Surgery	2,161	2,012	$223.92	68
Physician Assistant	1,179	1,113	$241.33	34
Ambulatory Surgical Center	1,018	964	$173.17	29
Undefined Physician type	279	268	$161.44	4
Nurse Practitioner	228	220	$238.70	11
Otolaryngology	227	218	$209.79	12
General Surgery	209	200	$185.75	7
Family Practice	168	164	$248.33	8
Emergency Medicine	37	33	$260.72	2
Osteopathic Manipulative Medicine	32	31	$239.46	2
Internal Medicine	32	24	$257.45	2
Interventional Pain Management	18	17	$247.68	1
Ophthalmology	14	14	$100.44	1

12052 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	7,042	$181.38	$139.33	150
Texas	5,219	$186.82	$147.58	131
California	5,013	$202.49	$139.74	123
North Carolina	4,304	$167.60	$138.68	73
Virginia	3,997	$176.98	$134.79	58
Pennsylvania	3,542	$169.86	$134.82	82
Ohio	2,789	$157.67	$123.99	53
Massachusetts	2,567	$174.66	$126.01	51
Georgia	2,373	$170.05	$141.04	53
Illinois	2,303	$187.82	$143.33	47
Arizona	2,281	$172.49	$136.35	52
Tennessee	2,138	$165.38	$139.02	47
South Carolina	2,071	$186.43	$152.01	42
Maryland	2,063	$197.63	$144.02	36
New York	2,029	$179.77	$128.84	45
Minnesota	1,920	$145.92	$115.25	42
Missouri	1,896	$162.93	$134.37	40
Kansas	1,655	$164.59	$139.08	22
Iowa	1,535	$160.20	$135.72	29
Colorado	1,441	$173.44	$131.27	35
Washington	1,365	$196.74	$133.33	28
Louisiana	1,339	$179.50	$151.87	28
Arkansas	1,257	$151.21	$134.28	20
Oregon	1,230	$189.53	$148.02	30
Indiana	1,222	$160.75	$134.92	28
Wisconsin	1,209	$138.66	$112.80	38
Mississippi	1,161	$173.24	$152.44	21
Connecticut	1,113	$181.34	$130.66	20
Oklahoma	1,096	$177.43	$145.63	25
Kentucky	1,090	$153.39	$131.37	24
Alabama	951	$172.69	$150.47	26
New Jersey	942	$181.66	$129.72	22
Utah	860	$161.69	$132.22	23
Michigan	798	$177.51	$139.49	27
New Hampshire	736	$144.34	$111.49	15
Idaho	675	$181.74	$153.51	22
Montana	633	$168.78	$132.79	12
New Mexico	598	$147.12	$117.41	9
Nebraska	533	$198.90	$167.77	21
West Virginia	531	$145.51	$122.15	9
Vermont	415	$153.30	$111.65	10
Wyoming	369	$195.86	$152.10	7
Nevada	301	$187.70	$137.46	12
Maine	280	$167.08	$133.78	8
Alaska	222	$183.87	$128.97	3
North Dakota	217	$116.26	$94.39	3
South Dakota	156	$162.66	$137.63	8
Rhode Island	93	$166.55	$128.98	3
Hawaii	89	$186.06	$130.55	5
Delaware	83	$234.05	$182.34	4
Puerto Rico	16	$155.72	$123.58	1
District of Columbia	11	$172.72	$134.72	1

Related codes

12032Intermediate repair of wound of scalp$250.68
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
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.