How much does Medicare pay for CPT 13131?

Medicare allowed an average of $229.32 per service and paid $181.59 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $863.69, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 13131?

Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 1.1-2.5 cm. It was billed 26,971 times to 25,731 Medicare beneficiaries by 814 providers in 2024.

Does 13131 pay differently in an office than a hospital?

Yes. The allowed amount averaged $234.47 in an office setting and $155.27 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 13131 most?

Dermatology, with 19,944 services from 589 clinicians. Next are Micrographic Dermatologic Surgery, Plastic and Reconstructive Surgery, Ambulatory Surgical Center.

CPT 13131

Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 1.1-2.5 cm

$229.32Medicare-allowed amount per service, averaged across 26,971 services

Providers submitted

$863.69

Asking price, not received

Medicare allowed

$229.32

The fee schedule figure

Medicare paid

$181.59

Balance is patient coinsurance

Providers submitted an average of $863.69 for this code and Medicare allowed $229.32 — 3.8× 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 $181.59 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $234.47
Hospital / facility: $155.27

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. 25,217 services were billed in an office setting and 1,754 in a facility.

Services: 26,971
Beneficiaries: 25,731
Providers billing it: 814
Total allowed: $6,184,990

What Medicare pays for CPT 13131

Across 26,971 services billed by 814 providers to 25,731 beneficiaries, Medicare allowed an average of $229.32 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 13131

Specialty	Services	Beneficiaries	Avg allowed	Providers
Dermatology	19,944	18,944	$215.95	589
Micrographic Dermatologic Surgery	2,998	2,930	$201.52	90
Plastic and Reconstructive Surgery	1,772	1,708	$361.16	58
Ambulatory Surgical Center	674	634	$179.67	18
Physician Assistant	641	611	$309.44	28
Otolaryngology	487	470	$376.89	18
Internal Medicine	152	145	$310.49	3
Family Practice	137	134	$239.55	3
Nurse Practitioner	62	62	$332.49	3
General Surgery	38	28	$435.26	1
Pathology	31	31	$207.72	1
Undefined Physician type	18	17	$180.01	1
General Practice	17	17	$240.96	1

13131 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	5,704	$246.91	$178.28	144
California	4,747	$255.39	$179.08	120
New York	1,492	$265.16	$174.91	61
Texas	1,264	$219.59	$167.82	49
Illinois	944	$217.53	$167.14	31
Arizona	855	$230.71	$167.83	29
Tennessee	840	$185.70	$159.00	24
Georgia	834	$203.20	$154.42	28
Ohio	716	$205.53	$160.12	19
South Carolina	706	$172.85	$142.38	11
New Jersey	640	$239.91	$169.69	19
Arkansas	596	$169.59	$149.28	8
Colorado	520	$209.77	$155.82	17
Pennsylvania	487	$214.94	$170.34	23
North Carolina	467	$205.38	$168.16	20
Massachusetts	467	$210.24	$152.15	21
Louisiana	434	$199.30	$163.70	8
Virginia	407	$267.16	$187.60	18
Maryland	327	$208.05	$152.67	11
Oregon	325	$266.40	$160.48	14
Michigan	320	$247.33	$169.56	10
Washington	301	$211.08	$155.06	11
Missouri	299	$207.12	$169.40	9
Utah	281	$184.37	$148.93	10
Kentucky	276	$176.84	$154.33	7
District of Columbia	253	$377.15	$259.03	3
Oklahoma	231	$177.67	$152.57	8
Indiana	230	$200.16	$170.20	9
Mississippi	212	$208.57	$177.51	6
Alabama	210	$188.42	$161.38	9
Iowa	206	$192.13	$156.67	6
Nebraska	183	$225.93	$185.62	7
Nevada	151	$223.51	$161.58	7
South Dakota	127	$146.20	$121.20	5
Rhode Island	119	$196.40	$152.52	1
Idaho	101	$188.71	$158.19	4
Minnesota	98	$191.30	$147.58	3
West Virginia	94	$180.02	$154.52	1
Kansas	93	$176.77	$151.92	4
Wisconsin	76	$181.88	$151.47	3
Montana	68	$190.78	$151.29	3
New Mexico	67	$191.97	$151.39	3
Connecticut	49	$208.84	$154.87	2
Delaware	42	$176.05	$139.31	3
ZZ	29	$388.86	$292.57	1
Maine	26	$183.47	$157.10	1
North Dakota	23	$110.95	$94.50	1
New Hampshire	19	$194.68	$151.50	1
Wyoming	15	$180.04	$142.79	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
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.