How much does Medicare pay for CPT 13151?

Medicare allowed an average of $235.39 per service and paid $186.57 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $969.32, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 13151?

Complicated repair of wound of eyelids, nose, ears, or lip, 1.1-2.5 cm. It was billed 18,453 times to 18,141 Medicare beneficiaries by 734 providers in 2024.

Does 13151 pay differently in an office than a hospital?

Yes. The allowed amount averaged $237.35 in an office setting and $209.18 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 13151 most?

Dermatology, with 13,304 services from 528 clinicians. Next are Micrographic Dermatologic Surgery, Plastic and Reconstructive Surgery, Ambulatory Surgical Center.

CPT 13151

Complicated repair of wound of eyelids, nose, ears, or lip, 1.1-2.5 cm

$235.39Medicare-allowed amount per service, averaged across 18,453 services

Providers submitted

$969.32

Asking price, not received

Medicare allowed

$235.39

The fee schedule figure

Medicare paid

$186.57

Balance is patient coinsurance

Providers submitted an average of $969.32 for this code and Medicare allowed $235.39 — 4.1× 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 $186.57 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $237.35
Hospital / facility: $209.18

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. 17,169 services were billed in an office setting and 1,284 in a facility.

Services: 18,453
Beneficiaries: 18,141
Providers billing it: 734
Total allowed: $4,343,652

What Medicare pays for CPT 13151

Across 18,453 services billed by 734 providers to 18,141 beneficiaries, Medicare allowed an average of $235.39 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 13151

Specialty	Services	Beneficiaries	Avg allowed	Providers
Dermatology	13,304	13,072	$219.22	528
Micrographic Dermatologic Surgery	2,733	2,696	$212.68	103
Plastic and Reconstructive Surgery	1,085	1,061	$388.85	47
Ambulatory Surgical Center	496	486	$276.91	19
Otolaryngology	410	404	$387.19	18
Physician Assistant	289	287	$333.92	13
Family Practice	45	44	$194.12	1
Undefined Physician type	40	40	$178.22	2
Pathology	25	25	$206.52	1
Internal Medicine	14	14	$360.55	1
General Practice	12	12	$445.42	1

13151 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	3,307	$253.10	$186.02	118
California	1,912	$262.73	$185.11	73
Texas	1,012	$224.55	$175.81	44
New York	947	$279.79	$181.70	34
Georgia	816	$233.65	$178.60	32
Illinois	620	$234.73	$176.84	24
Arizona	606	$244.06	$178.43	28
Ohio	553	$214.61	$165.23	18
Tennessee	550	$193.84	$167.90	20
Pennsylvania	507	$240.94	$179.63	28
Arkansas	502	$203.34	$174.49	9
North Carolina	447	$203.26	$169.89	23
Virginia	422	$229.68	$167.19	18
South Carolina	411	$234.78	$183.14	14
Missouri	405	$199.86	$166.64	16
Colorado	383	$255.21	$189.47	18
Massachusetts	338	$220.19	$161.50	17
Washington	323	$215.11	$168.02	13
Michigan	321	$232.70	$170.43	10
Louisiana	308	$217.63	$178.32	11
Maryland	269	$247.91	$179.08	12
Iowa	256	$205.90	$171.50	10
Kentucky	251	$209.53	$182.85	8
New Jersey	241	$253.03	$175.95	12
Indiana	233	$208.43	$177.86	12
Oklahoma	218	$198.33	$168.48	9
Utah	206	$199.77	$155.86	12
Alabama	196	$188.64	$166.87	8
Oregon	179	$260.92	$173.70	10
Nebraska	157	$257.33	$213.59	7
Wisconsin	148	$216.10	$160.19	7
Mississippi	143	$202.75	$173.34	4
South Dakota	136	$158.80	$132.78	6
Connecticut	109	$225.97	$169.77	6
Nevada	109	$214.15	$171.20	5
New Mexico	108	$209.83	$164.99	2
Minnesota	102	$212.38	$168.74	6
District of Columbia	97	$361.71	$247.24	3
Kansas	90	$215.12	$177.92	5
Idaho	89	$203.60	$170.75	4
West Virginia	83	$196.10	$167.03	3
Montana	78	$209.91	$164.99	3
Rhode Island	69	$218.36	$169.72	1
Wyoming	56	$293.48	$226.63	3
Delaware	36	$217.85	$168.96	2
Maine	32	$206.90	$170.51	2
North Dakota	24	$131.52	$107.75	1
Puerto Rico	20	$207.89	$165.05	1
Alaska	17	$244.09	$167.39	1
New Hampshire	11	$219.14	$165.10	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
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.