How much does Medicare pay for CPT 13152?

Medicare allowed an average of $268.00 per service and paid $212.74 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1239.64, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 13152?

Complicated repair of wound of eyelids, nose, ears, or lip, 2.6-7.5 cm. It was billed 40,453 times to 39,556 Medicare beneficiaries by 1,366 providers in 2024.

Does 13152 pay differently in an office than a hospital?

Yes. The allowed amount averaged $272.15 in an office setting and $231.67 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 13152 most?

Dermatology, with 28,624 services from 998 clinicians. Next are Micrographic Dermatologic Surgery, Plastic and Reconstructive Surgery, Ambulatory Surgical Center.

CPT 13152

Complicated repair of wound of eyelids, nose, ears, or lip, 2.6-7.5 cm

$268.00Medicare-allowed amount per service, averaged across 40,453 services

Providers submitted

$1239.64

Asking price, not received

Medicare allowed

$268.00

The fee schedule figure

Medicare paid

$212.74

Balance is patient coinsurance

Providers submitted an average of $1239.64 for this code and Medicare allowed $268.00 — 4.6× 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 $212.74 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $272.15
Hospital / facility: $231.67

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. 36,311 services were billed in an office setting and 4,142 in a facility.

Services: 40,453
Beneficiaries: 39,556
Providers billing it: 1,366
Total allowed: $10,841,404

What Medicare pays for CPT 13152

Across 40,453 services billed by 1,366 providers to 39,556 beneficiaries, Medicare allowed an average of $268.00 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 13152

Specialty	Services	Beneficiaries	Avg allowed	Providers
Dermatology	28,624	28,001	$254.09	998
Micrographic Dermatologic Surgery	6,562	6,464	$243.20	210
Plastic and Reconstructive Surgery	1,677	1,615	$442.91	68
Ambulatory Surgical Center	1,602	1,560	$283.85	33
Physician Assistant	919	884	$400.52	24
Otolaryngology	577	549	$449.34	15
Undefined Physician type	194	190	$230.39	5
Family Practice	75	73	$296.76	2
Nurse Practitioner	69	68	$406.41	4
Ophthalmology	60	60	$448.65	3
Pathology	58	58	$188.16	2
General Practice	21	19	$547.34	1
Osteopathic Manipulative Medicine	15	15	$233.92	1

13152 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	5,370	$293.91	$215.91	189
California	3,200	$314.79	$221.95	104
Texas	2,741	$273.26	$208.04	88
Georgia	1,747	$262.48	$205.94	50
New York	1,745	$319.07	$214.62	63
Pennsylvania	1,614	$255.19	$196.10	60
North Carolina	1,572	$254.05	$204.77	57
Arizona	1,444	$277.97	$207.02	49
Virginia	1,356	$279.31	$211.20	43
Illinois	1,190	$258.00	$198.39	39
Missouri	1,136	$236.93	$188.97	36
Massachusetts	1,114	$261.90	$193.37	35
Alabama	1,022	$222.53	$191.25	24
Maryland	988	$281.59	$191.29	27
South Carolina	986	$282.96	$220.99	27
Tennessee	956	$228.21	$196.23	36
Ohio	830	$245.49	$196.13	33
Washington	814	$244.58	$186.60	29
Wisconsin	774	$232.71	$182.95	25
Indiana	700	$239.70	$200.68	23
Colorado	690	$289.82	$214.62	30
Kansas	671	$229.51	$190.39	17
Kentucky	624	$244.25	$207.10	21
Arkansas	576	$219.52	$192.25	16
Michigan	511	$259.44	$200.72	22
Minnesota	457	$243.20	$196.89	19
New Jersey	416	$318.35	$216.78	18
Connecticut	413	$267.75	$201.53	16
Louisiana	400	$251.22	$211.72	18
Utah	382	$247.06	$197.83	15
Mississippi	380	$240.11	$206.88	7
Nevada	352	$250.24	$198.80	13
Oklahoma	331	$227.54	$192.56	11
West Virginia	293	$274.75	$199.63	5
Iowa	293	$258.38	$215.93	13
Oregon	285	$248.88	$189.98	12
Idaho	284	$221.72	$185.06	11
South Dakota	216	$198.32	$164.04	6
New Hampshire	215	$196.16	$154.90	8
Maine	190	$227.32	$182.57	6
Wyoming	185	$262.74	$211.26	5
Montana	182	$216.40	$171.66	6
Rhode Island	166	$248.99	$190.57	8
North Dakota	144	$169.59	$138.86	3
Delaware	102	$318.33	$212.93	5
Alaska	102	$286.43	$193.55	2
New Mexico	100	$235.02	$183.18	5
Hawaii	65	$250.48	$196.58	4
Nebraska	55	$355.40	$292.88	3
Vermont	43	$196.32	$161.13	2
District of Columbia	20	$277.00	$193.31	1
Puerto Rico	11	$243.76	$193.56	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
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.