How much does Medicare pay for CPT 13100?

Medicare allowed an average of $317.65 per service and paid $248.46 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $688.86, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 13100?

Complicated repair of wound of trunk, 1.1-2.5 cm. It was billed 1,553 times to 1,413 Medicare beneficiaries by 55 providers in 2024.

Does 13100 pay differently in an office than a hospital?

Yes. The allowed amount averaged $317.26 in an office setting and $360.66 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 13100 most?

Dermatology, with 1,163 services from 35 clinicians. Next are Physician Assistant, Plastic and Reconstructive Surgery, Internal Medicine.

CPT 13100

Complicated repair of wound of trunk, 1.1-2.5 cm

$317.65Medicare-allowed amount per service, averaged across 1,553 services

Providers submitted

$688.86

Asking price, not received

Medicare allowed

$317.65

The fee schedule figure

Medicare paid

$248.46

Balance is patient coinsurance

Providers submitted an average of $688.86 for this code and Medicare allowed $317.65 — 2.2× 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 $248.46 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $317.26
Hospital / facility: $360.66

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 1,539 services were billed in an office setting and 14 in a facility.

Services: 1,553
Beneficiaries: 1,413
Providers billing it: 55
Total allowed: $493,310

What Medicare pays for CPT 13100

Across 1,553 services billed by 55 providers to 1,413 beneficiaries, Medicare allowed an average of $317.65 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 13100

Specialty	Services	Beneficiaries	Avg allowed	Providers
Dermatology	1,163	1,037	$323.59	35
Physician Assistant	158	152	$284.41	9
Plastic and Reconstructive Surgery	107	104	$311.38	5
Internal Medicine	49	47	$327.62	2
Micrographic Dermatologic Surgery	38	37	$295.78	2
Nurse Practitioner	24	24	$265.72	1
Ambulatory Surgical Center	14	12	$360.66	1

13100 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	622	$318.63	$220.18	21
Florida	384	$339.87	$256.41	9
Arizona	103	$278.54	$217.20	5
New York	87	$316.30	$218.86	5
New Jersey	74	$343.16	$239.53	2
District of Columbia	54	$301.70	$214.56	1
Pennsylvania	53	$324.86	$257.44	2
Louisiana	34	$255.97	$198.35	1
Tennessee	31	$300.90	$247.59	2
Oklahoma	23	$267.87	$231.49	1
Nevada	22	$269.68	$211.00	1
Colorado	16	$281.54	$218.91	1
Texas	14	$249.61	$189.23	1
Delaware	14	$333.91	$266.98	1
Ohio	11	$267.00	$225.92	1
Maryland	11	$342.49	$136.45	1

Related codes

13132Complicated repair of wound of forehead$269.67
13121Complicated repair of wound of scalp$297.90
13101Complicated repair of wound of trunk$328.17
13152Complicated repair of wound of eyelids$268.00
13131Complicated repair of wound of forehead$229.32
13151Complicated repair of wound of eyelids$235.39
13122Complicated repair of wound of scalp$115.92
13120Complicated repair of wound of scalp$264.15
13102Complicated repair of wound of trunk$96.99
13133Complicated repair of wound of forehead$157.28
13160Extensive or complicated repair of surface wound reopening$650.97

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.