How much does Medicare pay for CPT 13121?

Medicare allowed an average of $297.90 per service and paid $234.05 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $962.21, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 13121?

Complicated repair of wound of scalp, arms, or legs, 2.6-7.5 cm. It was billed 195,686 times to 173,706 Medicare beneficiaries by 3,451 providers in 2024.

Does 13121 pay differently in an office than a hospital?

Yes. The allowed amount averaged $305.97 in an office setting and $209.30 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 13121 most?

Dermatology, with 139,985 services from 2,335 clinicians. Next are Micrographic Dermatologic Surgery, Physician Assistant, Plastic and Reconstructive Surgery.

CPT 13121

Complicated repair of wound of scalp, arms, or legs, 2.6-7.5 cm

$297.90Medicare-allowed amount per service, averaged across 195,686 services

Providers submitted

$962.21

Asking price, not received

Medicare allowed

$297.90

The fee schedule figure

Medicare paid

$234.05

Balance is patient coinsurance

Providers submitted an average of $962.21 for this code and Medicare allowed $297.90 — 3.2× 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 $234.05 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $305.97
Hospital / facility: $209.30

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. 179,354 services were billed in an office setting and 16,332 in a facility.

Services: 195,686
Beneficiaries: 173,706
Providers billing it: 3,451
Total allowed: $58,294,859

What Medicare pays for CPT 13121

Across 195,686 services billed by 3,451 providers to 173,706 beneficiaries, Medicare allowed an average of $297.90 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 13121

Specialty	Services	Beneficiaries	Avg allowed	Providers
Dermatology	139,985	123,630	$295.51	2,335
Micrographic Dermatologic Surgery	17,263	15,660	$246.26	262
Physician Assistant	13,032	11,653	$346.26	338
Plastic and Reconstructive Surgery	10,108	9,030	$360.79	211
Ambulatory Surgical Center	6,206	5,550	$274.06	78
Nurse Practitioner	2,755	2,477	$338.80	81
Otolaryngology	1,588	1,436	$379.16	24
General Surgery	755	710	$248.31	31
Family Practice	645	577	$331.94	13
Surgical Oncology	643	629	$181.52	30
Undefined Physician type	623	553	$212.86	6
Orthopedic Surgery	452	437	$160.04	13
Ophthalmology	393	312	$400.72	5
Pathology	390	329	$262.13	2
General Practice	305	221	$377.42	4

13121 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	40,209	$319.46	$242.82	560
California	24,611	$333.72	$231.00	449
Texas	12,056	$286.26	$222.11	224
New York	9,225	$320.57	$219.43	174
Arizona	8,274	$298.56	$230.00	145
Georgia	7,399	$265.63	$206.70	126
Pennsylvania	6,414	$287.89	$219.25	122
Illinois	5,589	$292.32	$223.92	101
North Carolina	5,217	$295.76	$235.47	91
New Jersey	4,772	$319.14	$225.24	94
Massachusetts	4,228	$297.35	$218.49	72
South Carolina	4,126	$294.01	$237.64	61
Missouri	4,074	$253.81	$207.37	62
Washington	3,775	$281.88	$209.02	78
Tennessee	3,764	$260.46	$220.51	76
Virginia	3,760	$313.72	$237.65	79
Ohio	3,747	$273.40	$222.62	81
Colorado	3,673	$323.81	$235.11	75
Alabama	3,585	$243.64	$210.69	53
Indiana	3,552	$260.91	$216.27	53
Maryland	2,696	$298.00	$208.94	50
Arkansas	2,575	$219.85	$192.34	30
Kentucky	2,518	$285.25	$241.27	36
Nevada	2,354	$291.20	$226.89	45
Michigan	2,301	$291.24	$227.36	63
Kansas	2,254	$236.65	$195.32	34
Wisconsin	1,508	$252.07	$195.85	36
Delaware	1,410	$304.75	$228.73	19
Oregon	1,358	$295.37	$220.59	38
Connecticut	1,321	$267.27	$195.04	22
Louisiana	1,298	$241.71	$204.16	26
Minnesota	1,265	$302.84	$229.46	32
Oklahoma	1,181	$241.01	$200.77	21
West Virginia	1,004	$274.39	$197.46	21
Mississippi	869	$250.36	$213.38	23
Utah	849	$265.67	$215.76	26
Iowa	809	$275.48	$229.04	18
New Hampshire	733	$270.69	$208.90	16
Wyoming	723	$228.39	$187.16	5
Rhode Island	649	$235.33	$181.32	12
South Dakota	627	$221.87	$181.62	11
Idaho	531	$225.70	$190.19	16
District of Columbia	461	$401.58	$279.06	7
New Mexico	448	$307.10	$246.57	14
Hawaii	418	$349.13	$258.28	9
Nebraska	396	$277.73	$223.68	13
North Dakota	390	$225.94	$185.08	7
Montana	274	$323.40	$248.38	11
Maine	237	$219.42	$176.98	6
Vermont	68	$229.55	$184.55	4
Puerto Rico	58	$400.38	$306.75	1
ZZ	28	$402.36	$310.65	1
Alaska	25	$301.67	$220.36	2

Related codes

13132Complicated repair of wound of forehead$269.67
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
13100Complicated repair of wound of trunk$317.65

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.