How much does Medicare pay for CPT 12053?

Medicare allowed an average of $180.85 per service and paid $143.60 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $804.39, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 12053?

Intermediate repair of wound of face, ears, eyelids, nose, lips, or mouth, 5.1-7.5 cm. It was billed 9,026 times to 8,767 Medicare beneficiaries by 391 providers in 2024.

Does 12053 pay differently in an office than a hospital?

Yes. The allowed amount averaged $188.45 in an office setting and $123.19 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 12053 most?

Dermatology, with 6,792 services from 303 clinicians. Next are Micrographic Dermatologic Surgery, Plastic and Reconstructive Surgery, Ambulatory Surgical Center.

CPT 12053

Intermediate repair of wound of face, ears, eyelids, nose, lips, or mouth, 5.1-7.5 cm

$180.85Medicare-allowed amount per service, averaged across 9,026 services

Providers submitted

$804.39

Asking price, not received

Medicare allowed

$180.85

The fee schedule figure

Medicare paid

$143.60

Balance is patient coinsurance

Providers submitted an average of $804.39 for this code and Medicare allowed $180.85 — 4.4× 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 $143.60 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $188.45
Hospital / facility: $123.19

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. 7,975 services were billed in an office setting and 1,051 in a facility.

Services: 9,026
Beneficiaries: 8,767
Providers billing it: 391
Total allowed: $1,632,352

What Medicare pays for CPT 12053

Across 9,026 services billed by 391 providers to 8,767 beneficiaries, Medicare allowed an average of $180.85 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 12053

Specialty	Services	Beneficiaries	Avg allowed	Providers
Dermatology	6,792	6,589	$183.15	303
Micrographic Dermatologic Surgery	1,882	1,844	$164.73	75
Plastic and Reconstructive Surgery	145	133	$260.85	4
Ambulatory Surgical Center	137	133	$178.82	5
Physician Assistant	35	35	$240.45	2
Undefined Physician type	21	21	$176.76	1
General Practice	14	12	$282.92	1

12053 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
North Carolina	663	$182.05	$151.64	24
Virginia	624	$183.74	$143.89	21
Florida	576	$197.93	$156.77	24
Texas	450	$182.63	$147.03	23
California	442	$192.08	$137.90	23
Pennsylvania	394	$171.99	$137.12	18
Ohio	364	$175.27	$133.76	14
Tennessee	344	$177.54	$153.38	15
Minnesota	321	$159.97	$126.61	19
Massachusetts	287	$200.87	$144.26	13
Georgia	286	$188.50	$155.88	15
Wisconsin	282	$130.15	$107.94	11
Illinois	261	$200.73	$161.39	12
Arizona	259	$188.00	$150.19	10
New York	256	$201.21	$142.30	10
Missouri	238	$160.58	$132.88	11
South Carolina	224	$213.29	$180.47	7
Kentucky	210	$170.59	$142.88	8
Washington	175	$167.85	$130.84	6
Arkansas	170	$163.48	$145.78	7
Oklahoma	158	$179.69	$154.85	8
Kansas	158	$183.56	$155.89	8
Maryland	150	$216.25	$150.50	7
Colorado	145	$201.90	$156.44	7
Indiana	132	$180.72	$150.79	6
New Hampshire	123	$148.54	$115.37	6
Mississippi	108	$163.88	$143.99	3
Louisiana	106	$198.53	$169.95	4
Iowa	103	$173.92	$149.49	6
Nebraska	91	$165.56	$142.30	2
Maine	82	$134.19	$109.76	3
Idaho	79	$169.02	$144.96	3
Montana	79	$178.34	$144.00	3
New Mexico	77	$138.22	$112.23	3
Michigan	75	$172.49	$135.80	5
Connecticut	75	$194.52	$144.00	4
Vermont	70	$152.31	$118.64	3
Rhode Island	70	$191.94	$146.43	2
New Jersey	61	$213.67	$151.70	3
Oregon	59	$187.20	$147.06	3
West Virginia	55	$156.43	$133.47	3
Utah	33	$135.83	$116.68	2
Nevada	33	$263.99	$205.44	1
North Dakota	25	$102.67	$84.04	1
Alabama	24	$181.80	$154.21	2
Wyoming	16	$178.20	$142.62	1
Hawaii	13	$212.65	$153.05	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
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.