🩹 CPT 12013 — Simple Repair Of Superficial Wounds Of Face, Ears, Eyelids, Nose, Lips And/Or Mucous Membranes; 2.6 Cm To 5.0 Cm
Quick Reference
wRVU: 1.19 | Global Period: 000 | Assistant Payable: No | Bilateral Indicator: 0 Rule: CPT 12013 carries a bilateral indicator of 0, meaning modifiers -50, -RT, and -LT are not recognized for this code; CPT instructs coders to sum the total wound length across all simple repairs within the same anatomic grouping on the same date rather than reporting multiple units or bilateral modifiers¹⁴.
📋 Clinical Description
CPT 12013 describes single-layer, superficial closure of a laceration or open wound located on the face, ears, eyelids, nose, lips, or mucous membranes, measuring a total of 2.6 cm to 5.0 cm¹. The repair may use sutures, staples, tissue adhesive (such as 2-octyl cyanoacrylate), adhesive strips, or a combination, and it applies only when the wound involves the epidermis, dermis, or subcutaneous tissue without significant involvement of deeper structures¹. Compared to its smaller sibling 12011 (2.5 cm or less) and larger sibling 12014 (5.1 cm to 7.5 cm), 12013 sits in the middle tier of the same size-based ladder for the same anatomic grouping, distinguished purely by total measured wound length rather than repair technique.
Unlike the trunk/extremity simple repair family (12001–12007), the face/ear/eyelid/nose/lip/mucous-membrane grouping reported by 12013 reflects the higher cosmetic sensitivity and vascularity of these structures, which drives a higher wRVU than the equivalent-size code in the other anatomic group. If the wound instead requires layered closure of subcutaneous tissue and fascia, the encounter escalates to intermediate repair code 12052 rather than 12013.
This procedure may be performed in the following clinical contexts:
- Emergency department or urgent care laceration repair — a patient presents with a fresh traumatic facial laceration from a fall, assault, or sharp object injury requiring same-day closure.
- Office-based dermatology or family medicine encounter — a superficial facial wound from a minor accident is closed during a scheduled or walk-in visit.
- Post-Mohs or post-excision closure — after a small skin lesion excision on the face or ear, the resulting defect is closed in a single layer.
- Pediatric trauma care — children frequently sustain small facial or lip lacerations from falls, and simple single-layer closure is standard when depth is limited to skin and subcutaneous tissue.
🔬 Anatomical & Procedural Considerations
| Variant | Mechanism | Key Notes |
|---|---|---|
| Single laceration, single-layer suture closure | Wound edges are approximated with simple interrupted or running sutures through epidermis and dermis only. | Most common presentation for 2.6–5.0 cm facial lacerations; local anesthesia and hemostasis are bundled into the code. |
| Tissue adhesive closure | Skin edges are aligned and sealed with cyanoacrylate adhesive instead of sutures or staples. | CPT treats adhesive-only closure the same as suture closure for physician billing; hospital outpatient facilities use HCPCS G0168 instead, not 12013. |
| Multiple wounds, same classification and grouping | Two or more simple facial-region lacerations are present; their lengths are added together for one cumulative code selection. | If combined length lands in the 2.6–5.0 cm range, report 12013 once — never stack separate units or separate codes for each wound. |
Clinical Pearl
Because the bilateral indicator is 0, a laceration crossing the midline of the lip or affecting both the right and left eyelid margins is still reported as one 12013 unit based on total summed length, never with modifier -50 or two units¹⁴. Documentation should always state total wound length in centimeters, not inches, to support code selection.
✅ Procedure Includes
- Single-layer closure with sutures, staples, tissue adhesive, or adhesive strips, alone or in combination.
- Local or topical anesthesia administered by the same physician performing the repair.
- Hemostasis achieved by any method (pressure, cautery, ligature) during the repair.
- Simple wound cleansing, irrigation, and exploration that does not rise to extensive debridement.
- Application of a wound dressing at the conclusion of the procedure.
- Physician documentation of wound measurement, anatomic site, and closure method to support code-level specificity.
❌ Excludes / Do Not Report Together
| Code | Description | Relationship |
|---|---|---|
| 12011 | Simple repair, face/ears/eyelids/nose/lips/mucous membranes, 2.5 cm or less | Mutually exclusive by size within the same encounter; if total length changes after summing additional wounds, select the single code matching the new cumulative total instead of reporting both. |
| 12014 | Simple repair, same anatomic grouping, 5.1 cm to 7.5 cm | Represents the next size tier; do not report alongside 12013 for wounds in the same classification and grouping on the same date — sum the lengths and bill one code. |
| 12052 | Intermediate repair, face/ears/eyelids/nose/lips/mucous membranes, 2.6 cm to 5.0 cm | If layered closure of subcutaneous tissue or fascia is performed, or extensive debridement of a contaminated wound is required, the encounter reclassifies to intermediate repair instead of simple repair. |
| 13131 | Complex repair, same anatomic grouping, 2.6 cm to 7.5 cm | Reserved for repairs requiring scar revision, extensive undermining, or retention sutures; a straightforward single-layer closure does not meet complex-repair criteria. |
Bundling Alert
CPT 12013 carries a 000-day global period, so same-day evaluation and management services tied to the decision to repair the wound are bundled unless a significant, separately identifiable E/M service is documented and reported with modifier **-25**¹⁴. Per the 2026 NCCI Policy Manual, several add-on and imaging-guidance codes edit against 12013 with a bundling indicator of 0, meaning no modifier can unbundle them regardless of documentation⁴.
🌳 Code Tree — Surgery: Integumentary System, Repair (Closure)
CPT 12001-13160 Repair (Closure)
│
├── 12001-12007 Simple Repair (Scalp, Neck, Axillae, External Genitalia, Trunk, and/or Extremities)
│ ├── 12001 Simple repair, 2.5 cm or less
│ └── 12007 Simple repair, over 30.0 cm
│
├── 12011-12018 Simple Repair (Face, Ears, Eyelids, Nose, Lips, and/or Mucous Membranes)
│ ├── 12011 Simple repair, 2.5 cm or less (Global: 000)
│ ├── ▶▶ 12013 ◀◀ Simple repair, 2.6 cm to 5.0 cm ← YOU ARE HERE (Global: 000)
│ ├── 12014 Simple repair, 5.1 cm to 7.5 cm (Global: 000)
│ └── 12015 Simple repair, 7.6 cm to 12.5 cm (Global: 000)
│
└── 12031-12057 Intermediate Repair
├── 12051 Intermediate repair, face/ears/eyelids/nose/lips/mucous membranes, 2.5 cm or less
└── 12052 Intermediate repair, face/ears/eyelids/nose/lips/mucous membranes, 2.6 cm to 5.0 cm💰 RVU & Reimbursement Profile
| Component | Value |
|---|---|
| Work RVU | 1.19² |
| Global Period | 000 — no postoperative days; same-day E/M is bundled² |
| Bilateral Indicator | 0 — 150% bilateral adjustment does not apply; modifiers -50/-RT/-LT are not recognized because CPT already requires summing wound lengths within the same grouping² |
| Assistant Surgeon | 0 — Payment restricted unless documentation establishes medical necessity for an assistant on this minor procedure² |
| Co-Surgeon | 0 — Co-surgery not permitted; this is a single-surgeon procedure² |
| Team Surgery | 0 — Team surgery concept does not apply² |
| PC/TC Split | 0 — Physician service code; RVUs already represent the complete global service² |
| Modifier -51 Exempt | No — subject to standard multiple-procedure reduction when billed with other same-session procedures |
| Anesthesia | Not separately reportable — local/topical anesthesia and hemostasis are bundled into the code¹ |
Bilateral Billing Rules
Because the bilateral indicator is 0, do not append modifier -50, -RT, or -LT to 12013 even when wounds affect both the right and left side of the face. Instead, add together the total length of all simple repairs in the same anatomic classification and grouping performed on the same date, then report the single code matching that cumulative total¹⁴.
🏷️ Modifier Reference
| Modifier | Name | When to Apply |
|---|---|---|
| -25 | Significant, Separately Identifiable E/M Service | Append to an E/M code billed the same day as 12013 when the physician performs and documents a distinct evaluation beyond the decision to repair the wound. |
| -59 | Distinct Procedural Service | Use when 12013 is reported with another procedure that would normally bundle, and documentation supports the services were performed at separate anatomic sites or separate patient encounters. |
| -52 | Reduced Services | Apply when the repair is partially completed or a smaller portion of the planned closure is performed than typically required. |
| -53 | Discontinued Procedure | Apply when the repair is started but terminated early due to a patient-related complication before completion. |
| -22 | Increased Procedural Services | Use when the repair requires substantially greater physician work than typically described, with supporting documentation of the additional complexity. |
| -76 | Repeat Procedure by Same Physician | Apply if a separate, medically necessary 12013 repair is performed later the same day by the same physician on a distinct new wound, not part of the original repair. |
🩺 Common ICD-10-CM Pairings
Primary Diagnosis Group
| ICD-10 | Description | HCC? | Notes |
|---|---|---|---|
| S01.111A | Laceration without foreign body of right eyelid and periocular area, initial encounter | ❌ No | Common pairing for eyelid-margin lacerations closed with single-layer suture repair³. |
| S01.112A | Laceration without foreign body of left eyelid and periocular area, initial encounter | ❌ No | Mirror-image left-sided eyelid laceration; laterality must match the documented side³. |
| S01.511A | Laceration without foreign body of lip, initial encounter | ❌ No | Frequently paired with 12013 for facial trauma involving the lip margin³. |
| S01.81XA | Laceration without foreign body of other part of head, initial encounter | ❌ No | Used for cheek, forehead, or other head-region lacerations not captured by a more specific S01 subcategory³. |
Coding Specificity Reminder
Always report the 7th character matching encounter type (A = initial, D = subsequent, S = sequela) and never default to an unspecified S01 code when laterality or exact anatomic site is documented in the chart³.
🏥 MS-DRG Considerations
CPT 12013 is a minor physician-fee-schedule procedure and does not drive a distinct MS-DRG assignment; when performed during an inpatient admission, the professional service bills separately while the facility’s resource cost folds into the encompassing MS-DRG for the underlying admission. There is no National Coverage Determination (NCD) specific to simple wound repair codes 12011–12018, so coverage for 12013 is governed by Medicare’s general reasonable-and-necessary standard rather than a dedicated national policy⁴. A review of the Medicare Coverage Database also shows no Local Coverage Determination (LCD) written specifically for the 12001–13160 repair family; the related wound-care LCD (L37228) addresses debridement, negative pressure wound therapy, electrical stimulation, and topical oxygen therapy for chronic wounds and explicitly does not extend to acute traumatic laceration repair⁵. Cross-checking the CMS PFS Look-Up Tool confirms 12013 carries Status Indicator A (active, separately payable), a 0-day global period, and no NCD/LCD-driven payment edits, meaning reimbursement hinges entirely on accurate wound-length documentation and correct ICD-10-CM linkage rather than coverage-determination criteria².
🔧 ICD-10-PCS Equivalents
| PCS Code | Full Description | Modality |
|---|---|---|
| 0HQ1XZZ | Repair Skin, Face, External Approach | Open/percutaneous suture repair |
| 0HQ2XZZ | Repair Skin, Right Ear, External Approach | Open/percutaneous suture repair |
| 0HQ3XZZ | Repair Skin, Left Ear, External Approach | Open/percutaneous suture repair |
| 0HQMXZZ | Repair Skin, Nose, External Approach | Open/percutaneous suture repair |
PCS Character Analysis
| Position | Character | Value | Definition |
|---|---|---|---|
| 1 | Section | 0 | Medical and Surgical section, covering the vast majority of procedural interventions. |
| 2 | Body System | H | Skin and Breast body system, appropriate for superficial integumentary repair. |
| 3 | Root Operation | Q | Repair — restoring a body part to its normal anatomic structure and function without a specific objective qualifier. |
| 4 | Body Part | Varies (1, 2, 3, M) | Identifies the specific facial subsite — Face, Right Ear, Left Ear, or Nose. |
| 5 | Approach | X | External approach, since the repair is performed directly through the skin surface without instrumentation into a body cavity. |
| 6 | Device | Z | No device — sutures and adhesives are supplies, not implantable devices, in PCS logic. |
| 7 | Qualifier | Z | No qualifier — simple repair carries no additional PCS distinction. |
Root Operation Comparison
- Repair (Q) is used broadly whenever no other root operation more precisely fits, which applies to simple suture closure of a laceration.
- This differs from Alteration or Reconstruction, which apply to procedures changing appearance or restoring anatomy after significant tissue loss, not simple laceration closure.
📝 Coding Examples
Example 1
Clinical Scenario: A 34-year-old presents to the emergency department after a fall, sustaining a 3.5 cm laceration to the forehead involving only the epidermis and dermis. The physician performs a single-layer closure using nylon sutures under local anesthesia.
| Field | Code | Rationale |
|---|---|---|
| CPT | 12013 | Wound length of 3.5 cm falls within the 2.6–5.0 cm range for the face/ears/eyelids/nose/lips/mucous membranes grouping, and closure was single-layer only. |
| PDx | S01.81XA | Forehead is coded as “other part of head” since it does not fall under a more specific S01 subcategory, initial encounter. |
Note
Document total wound length in centimeters and confirm no fascia or muscle involvement to support simple-repair code selection rather than intermediate repair.
Example 2
Clinical Scenario: A patient sustains a 3.2 cm right eyelid margin laceration and a separate 1.5 cm lip laceration from a dog bite. Both wounds are within the same CPT anatomic grouping (face/ears/eyelids/nose/lips) and both require simple single-layer closure.
| Field | Code | Rationale |
|---|---|---|
| CPT 1 | 12013 | Total summed length of 4.7 cm (3.2 cm + 1.5 cm) falls within the 2.6–5.0 cm tier; report once, not as two separate codes. |
| CPT 2 | N/A | No second CPT code is reported for the lip wound since lengths are combined within the same classification and grouping. |
| PDx | S01.111A | Right eyelid laceration is sequenced as the primary or co-primary diagnosis supporting the repair. |
Warning
Example 3
Clinical Scenario: A patient has a 3.0 cm ear laceration (face/ear grouping) and, from a separate mechanism, a 2.2 cm forearm laceration (trunk/extremity grouping) repaired during the same encounter.
| Field | Code | Rationale |
|---|---|---|
| CPT | 12013--59 | Ear laceration belongs to a different anatomic grouping than the forearm wound, so it is reported separately with modifier 59 to indicate a distinct procedural service. |
| PDx | S01.81XA | Represents the head-region wound closed with 12013. |
Global period reminder, if applicable
Because both codes carry 000-day global periods, no postoperative global-period conflict exists, but payer bundling logic still requires modifier support when two simple repair codes from different groupings are billed together.
⚠️ Common Coding Pitfalls
- Pitfall 1: Reporting multiple units or separate codes for multiple simple facial wounds instead of summing total length within the same classification and anatomic grouping, which leads to overbilling and audit risk.
- Pitfall 2: Appending modifier -50, -RT, or -LT to 12013, which is invalid because the bilateral surgery indicator is 0 and these modifiers are not recognized for this code.
- Pitfall 3: Failing to distinguish simple from intermediate repair when layered closure of subcutaneous tissue or fascia was actually performed, resulting in undercoding to 12013 instead of 12052.
- Pitfall 4: Separately billing local anesthesia, hemostasis, or simple wound irrigation, all of which are bundled into the 12013 global service and not separately payable.
- Pitfall 5: Using an unspecified or laterality-vague ICD-10-CM code when the documentation clearly supports a more specific right/left or site-specific S01 code.
- Pitfall 6: Billing ab without modifier -25 or without documentation supporting a significant, separately identifiable evaluation beyond the decision to repair the wound.
📎 Sources
1. American Medical Association. *CPT Professional Edition 2026.* AMA; 2026. 2. Centers for Medicare & Medicaid Services. *Physician Fee Schedule Look-Up Tool.* CMS.gov; 2026. https://www.cms.gov/medicare/physician-fee-schedule/search 3. ICD10Data.com. *2026 ICD-10-CM Diagnosis Codes S01.111A, S01.112A, S01.511A, S01.81XA.* https://www.icd10data.com 4. Centers for Medicare & Medicaid Services. *National Correct Coding Initiative Policy Manual, Chapter 13.* CMS.gov; 2026. 5. Centers for Medicare & Medicaid Services. *Local Coverage Determination L37228 - Wound Care.* Medicare Coverage Database; 2026. https://www.cms.gov/medicare-coverage-databaseSources listed above correspond to superscript citations throughout this note. Verify all Medicare payment figures against your current CMS PFS Lookup tool and applicable MAC LCD prior to claim submission. Please use the latest AAPC/AHIMA Coding Books to verify each code within this note.