Stitches cost by wound length: the 2026 repair code ladder

Length, repair type and body area pick the code

Every wound repair code in the 12001 to 13153 range is the meeting point of three facts written in the procedure note. The first is the length of the repaired wound in centimeters. The second is the repair type, which the CPT code set divides into simple, intermediate and complex. The third is the body area, because the code set groups the scalp, neck, trunk and limbs separately from the face, ears, eyelids, nose and lips. Change any one of the three and the code changes, and with it the anchor.

The CMS fee schedule file shows the groupings in its short descriptors. Codes 12001 to 12007 are abbreviated "s/n/ax/gen/trnk": scalp, neck, axillae, external genitalia and trunk; the full CPT descriptor, not reproduced here, adds the extremities, including the hands and feet. Codes 12011 to 12018 are "f/e/e/n/l/m": face, ears, eyelids, nose, lips and mucous membranes. Intermediate codes 12031 to 12037 are "s/a/t/ext": scalp, axillae, trunk and extremities; the full CPT descriptor for this group leaves out the hands and feet. Complex codes 13100 to 13102 cover the trunk, and 13120 to 13122 cover the scalp, arms and legs.

The repair type is defined in the CPT code set, which the American Medical Association publishes and this site does not reproduce. In billing terms, the three types form a ladder of increasing physician work, and the CMS relative value file states that work as a number. At the smallest length band on the arm, the work value is 0.82 units for the simple repair 12001, 1.95 for the intermediate repair 12031 and 3.15 for the complex repair 13120. The clinician who closes the wound records which repair was done. Which type a wound should get is a care question outside this site; whether the billed code matches what the note records is a billing question you can check.

A 2 cm cut on the forearm shows how far apart the three types sit at the same length. Each row below is the code that the forearm and the 2 cm length point to under one repair type.

Source: CMS PFS RVU26D (October 2026 release) and GPCI2026, Michigan Locality 01, CY2026 conversion factor $33.4009. Computed October 31, 2026. Medicare reference amounts only; a wound repair bill sets its own price.

The complex repair at 2 cm is roughly three times the simple repair at the non-facility rate: $351.59 against $115.20. That spread is wider than the effect of the wound growing from 2 cm to 12 cm under the simple codes, where the anchor goes from $115.20 to $165.91. Repair type moves the anchor more than length does across the first few bands.

Simple repairs, 12001 to 12007: the 2026 anchors

These are the simple repair codes for the scalp, neck, armpits, genitals, trunk and limbs. The physician columns are computed from the October 2026 CMS relative value file: the work value times the Michigan Locality 01 work index of 1.000, plus the practice expense value times 0.965, plus the malpractice value times 1.686, all times the CY2026 conversion factor of $33.4009. The same arithmetic returns $73.73 for the emergency visit code 99283 at the facility rate, the figure this site already stores for that code, which checks the method. The hospital column is the CMS hospital outpatient Addendum B for October 2026.

Sources: CMS PFS RVU26D and GPCI2026, Michigan Locality 01, CY2026; CMS OPPS October 2026 Addendum B, national unadjusted payments before wage-index adjustment. Checked October 31, 2026. Medicare anchors, not your bill. Code 12003 does not appear in the file; the band numbering skips it.

The non-facility column climbs with every band, from $115.20 to $265.14. The facility column climbs too but starts lower, $47.84 for 12001, because the facility rate assumes a hospital or similar setting supplies the room, staff and supplies and pays for them through its own claim. For 12001 the gap between the two columns is $67.36, and all of it is practice expense, since the work and malpractice values are the same in both columns: the file gives 12001 a non-facility practice expense value of 2.41 units against 0.32 in a facility.

The face has its own simple codes. A 2.5 cm or smaller simple repair on the face, ears, eyelids, nose or lips is 12011, at $141.48 non-facility and $59.29 facility, and 2.6 to 5.0 cm is 12013, at $148.42 and $61.72. The face bands are narrower than the body bands: 12013 stops at 5.0 cm where 12002 runs to 7.5 cm. And at the same 2.5 cm or less band, a cut on the cheek bills as 12011, $26.28 more at the non-facility rate than 12001 for the same length on the forearm.

Intermediate and complex repairs: the upper rungs

Intermediate repairs on the scalp, armpits, trunk and limbs follow the same length bands as the simple codes. Complex repairs use different bands and an add-on code for extra length, so a long complex repair is billed as a base code plus one or more add-on units.

Sources: CMS PFS RVU26D and GPCI2026, Michigan Locality 01, CY2026; CMS OPPS October 2026 Addendum B, national unadjusted. Checked October 31, 2026. Add-on codes 13102 and 13122 carry global indicator ZZZ: their global period follows the base code. Medicare anchors, not your bill.

Two features of this table matter for the bill. Every intermediate and complex code with its own length band carries a 10-day global period, where the simple codes carry 0 days; that difference decides whether a follow-up visit is already paid for. And the complex codes begin at 1.1 cm, so the file has no complex code for a wound of 1 cm or less.

The add-on codes price length in steps. A complex repair on the trunk is 13101 for 2.6 to 7.5 cm, and each further step adds one unit of 13102. The rows below are lengths chosen to show one, two and three code lines; they are inputs to the arithmetic, not typical wounds.

Source: CMS PFS RVU26D and GPCI2026, Michigan Locality 01, CY2026. Add-on units are not reduced: the file gives 13102 a multiple procedure indicator of 0. Medicare anchors, not your bill.

The add-on is not discounted. The Medicare Claims Processing Manual, chapter 12, section 40.6, says that when the multiple procedure field holds a 0, the multiple surgery rules do not apply to that code, and the RVU file gives 0 to both 13102 and 13122. On the hospital side the add-ons are status N, packaged into the base code's payment, so a 17 cm complex trunk repair has the same hospital outpatient line, $755.08 at APC 5053, as a 7 cm one.

The hospital column moves in blocks, not bands

The hospital outpatient system does not price each code. It sorts codes into ambulatory payment classifications, called APCs, and pays one national rate per APC, adjusted for local wages at payment time. The hospital figures here are the national unadjusted rates, before that wage adjustment, so a hospital in Michigan Locality 01 or anywhere else is paid a different amount after adjustment.

Four skin repair APCs carry the wound codes in Addendum B. APC 5051 pays $204.98, APC 5052 pays $415.32, APC 5053 pays $755.08 and APC 5054 pays $2,107.97. The simple codes 12001, 12002 and 12004 all sit in APC 5051, so a 12 cm simple repair has the same hospital rate as a 1 cm one. The simple codes 12005 and 12006 move up to APC 5052. The simple repair over 30 cm, 12007, appears in Addendum B back in APC 5051 at $204.98, below the two bands under it. Intermediate repairs 12031 through 12035 share APC 5052; 12036 is in APC 5053, and 12037 jumps to APC 5054 at $2,107.97.

The status indicator is the second piece. Addendum D1 of the CY2026 hospital outpatient final rule defines what each letter means for payment.

Sources: CMS OPPS October 2026 Addendum B; CMS CY2026 OPPS final rule Addendum D1, status indicator definitions. Checked October 31, 2026.

The Q1 status on the small simple codes is why a hospital line for a 2 cm simple repair is conditional. If the same claim carries another procedure with status T, such as an intermediate repair of a second wound, the simple repair is folded into that payment and shows no separate rate. If no S, T or V code is on the claim, D1 says the simple repair is paid through its own APC. Emergency visit codes are J2, a letter not on the S, T or V list. Whether an emergency claim triggers a comprehensive payment depends on the whole claim. For that reason the simple-repair hospital lines below are marked conditional, and the intermediate case, a status T code with its own payment, serves as the firm example.

Office rate or facility rate: the setting decides

The physician's fee and the hospital's line are separate layers, and each is priced under its own system. For the physician, chapter 12, section 20.4.2, of the claims manual says the place of service code on the claim determines whether the facility or non-facility rate is paid. It lists an emergency room in a hospital (place of service 23), and on-campus and off-campus hospital outpatient departments (22 and 19), among the settings paid at the facility rate. It lists an office (11) and an urgent care facility (20) among the settings paid at the non-facility rate.

That split produces the two physician pictures for one code. At an independent urgent care clinic billing place of service 20, the clinic's clinician is paid the non-facility amount, $115.20 for 12001, and that one figure has to cover the room, the suture kit and the staff. In an emergency department, the emergency physician is paid the facility amount, $47.84, and the hospital sends its own claim for the department's costs. The facility rate is lower only because the other half of the cost has moved onto a second bill.

A clinic with an urgent care sign can still be a hospital outpatient department, and then the hospital layer comes back. A hospital outpatient clinic visit is billed with HCPCS G0463, status J2 at APC 5012, $136.02 national unadjusted in the October 2026 Addendum B. Our facility fee guide covers hospital facility charges at outpatient clinics. Whether a separate facility line will be billed is the first question to ask before a repair at any clinic attached to a hospital system.

A 2 cm forearm cut, billed two ways

Take a 2 cm cut on the forearm closed with a simple repair. Length and body area point to 12001. The figures below are Medicare anchors for that code in each setting. They show the structure of each bill, not what any clinic or hospital charges a self-pay patient.

At an independent urgent care clinic

The repair line is 12001 at $115.20, the non-facility anchor. The claim may also carry a visit code. The NCCI policy manual, chapter III, section B, says the decision to perform a minor procedure is included in the procedure's payment and is not billed as a separate visit, but a significant and separately identifiable evaluation unrelated to that decision can be billed with modifier 25. Being a new patient does not, by itself, qualify for the separate visit, the same section adds. If a separate new-patient visit at level 99203 were billed, its non-facility anchor is $119.18, and the two physician lines would be $234.38 in Medicare terms. Without the separate visit, the bill is the one repair line.

For a person with Original Medicare, the repair is a physician service under Part B. The 2026 Part B deductible is $283.00, more than the $115.20 anchor, so a person who has not met it pays the whole allowed amount toward the deductible. Once the deductible is met, Medicare pays 80 percent and the patient's 20 percent coinsurance on $115.20 is $23.04.

In a hospital emergency department

The physician's claim now uses the facility rate: 12001 at $47.84. A typical companion line is an emergency visit code; at level 3, 99283, the facility-rate anchor is $73.73, and the same modifier 25 rule decides whether it is paid alongside the repair. If both are paid, the physician's two lines are $121.57.

The hospital sends a separate claim. Its visit line for 99283 is status J2, APC 5023, $278.89 national unadjusted. Its repair line for 12001 is status Q1 at APC 5051, $204.98, payable separately only when no S, T or V code is on the claim. If it is separately payable, the hospital's two lines are $483.87 national unadjusted. Neither hospital figure is added to the physician figures here: the two claims are priced under different systems and sent by different organizations.

The setting changes how many bills arrive and who sends them. At the urgent care clinic the 2 cm repair is one line on one bill. In the emergency department the same code appears on two bills, at two different rates, beside a visit code that also appears on both.

An 8 cm forearm cut in the emergency department

Now take an 8 cm cut on the same forearm, treated in a hospital emergency department and assigned a level 4 visit. The length falls in the 7.6 to 12.5 cm band for simple and intermediate repairs and beyond the 7.5 cm base band for complex repairs. The table shows the repair line under each repair type, physician and hospital side by side but never added together.

Sources: CMS PFS RVU26D and GPCI2026, Michigan Locality 01, CY2026; CMS OPPS October 2026 Addendum B, national unadjusted. Checked October 31, 2026. Medicare anchors, not your bill.

Take the intermediate case line by line, since its hospital line has a firm status. The physician bills 99284 at the facility-rate anchor of $125.73 and 12034 at $186.51. If the visit meets the modifier 25 test, the physician's two lines are $312.24, and with Original Medicare after the deductible, 20 percent coinsurance on them is $62.45.

The hospital bills 99284 as status J2, APC 5024, $426.30 national unadjusted, and 12034 as status T, APC 5052, $415.32. The two hospital lines are $841.62 national unadjusted, and the Addendum B minimum unadjusted copayments for them are $85.26 and $83.07, $168.33 together. The hospital and physician totals stay separate because they come from separate systems and separate organizations.

In dollars, the repair type moves the hospital line more than the physician line. At the physician's facility rate, the intermediate repair is $107.31 more than the simple repair. On the hospital side the simple repair sits in APC 5051 at $204.98 and the intermediate repair in APC 5052 at $415.32, a gap of $210.34. The complex version, 13121 with one unit of the add-on 13122, has a physician line of $295.17 and the same APC 5052 hospital rate as the intermediate repair, because 13121 is in APC 5052 and the add-on is packaged.

The same 8 cm cut at an independent urgent care clinic would be one physician line at the non-facility rate: $165.91 for the simple repair 12004 or $335.75 for the intermediate repair 12034, with no hospital line. The clinic's own price list, not the anchor, decides what a self-pay patient is asked to pay.

Two cuts repaired at one visit

When two wounds are repaired with different codes on the same day, the physician fee schedule ranks them. Chapter 12, section 40.6, of the claims manual says that for codes with multiple procedure indicator 2, which the RVU file gives every wound repair base code in the tables above, the highest-valued procedure is paid at 100 percent of its fee schedule amount and the second through fifth at 50 percent.

Picture a 4 cm cut on the cheek closed with a simple repair, 12013, and a 5 cm cut on the forearm closed with an intermediate repair, 12032, both in an emergency department. At the physician's facility rate, 12032 is $168.36 and ranks first at full value. 12013 is $61.72 and ranks second, paid at half: $30.86. The two repair lines are $199.22 in Medicare terms. At an office or urgent care clinic, the same pair at the non-facility rate comes to $372.79.

The hospital applies its own rules to the same pair. 12032 is status T, so it has a separate APC 5052 payment of $415.32. 12013 is status Q1, and with a status T code on the same claim, Addendum D1 says it is packaged: no separate hospital payment for the cheek repair. For the same two wounds, the hospital claim pays one repair line and the physician claim pays one and a half.

A billing office that lists both repairs at full value on the physician side has not applied the ranking, at least for Medicare. A commercial plan or a self-pay price list may use its own multiple procedure rule, so ask the billing office which rule it applied and why.

Four facts on the visit summary that set the repair line

Unlike a visit level, a wound repair code rests on facts the clinician writes down at the time: a measurement, a repair type and a body site. Ask for the procedure note or the visit summary and set it beside the statement.

• Length. The note records the repaired length in centimeters. The code's band should contain it: a 6 cm repair on the trunk is 12002 for a simple repair, not 12004. The CPT code set adds together the lengths of repairs of the same type in the same body-area group, so two simple 2 cm cuts on one forearm can correctly appear as one 12002 line for 4 cm.
• Repair type. The note records simple, intermediate or complex. An intermediate code with a note that says simple, or the reverse, is a question for the billing office, not a clinical judgment for you to make.
• Body area. A cut on the face billed with a 12001 to 12007 body code, or a forearm cut billed with a face code, does not match the code's group.
• Count and rank. Two wounds with two codes should show the multiple procedure ranking on a Medicare physician claim; add-on units of 13102 or 13122 should match the length beyond the base band.

Then check the setting. A bill from an urgent care clinic that shows a hospital facility line means the clinic billed as a hospital outpatient department; ask whether that was stated when you checked in. An emergency bill with only one claim may mean the second, from the physician group, is still coming. The emergency visit level guide explains the visit-code half of an emergency bill, which is often the larger line beside the repair.

Where the two documents disagree, put both in one sentence and send it to the billing office in writing. For example, a summary recording a 4 cm simple forearm repair against a statement showing 12004, the 7.6 to 12.5 cm band, is a request to review the code and reissue the statement, with a copy of the summary attached. Our itemized bill guide covers what to do if the answer does not resolve it. More pages on emergency and walk-in costs are on the emergency and urgent care costs hub.

Paying out of pocket: turning the ladder into a price request

Stitches have no self-pay range on this site: the public price sources checked did not pass its verification standard. What the ladder gives an uninsured patient is the vocabulary for a precise question. "How much are stitches?" has no single answer. "What is your self-pay price for CPT 12002, and will you also bill a visit code?" does.

At a walk-in clinic, the useful questions are short. Ask for the self-pay price of the repair code for your wound length and repair type, whether a visit code will be billed with it, whether supplies, an injection or an X-ray are priced separately, and whether the clinic is part of a hospital that bills a facility fee. The urgent care price guide lists the CY2026 anchors for those other common lines, and our cash price request guide has wording for getting the answer in writing.

A formal estimate has a timing limit. Under 45 CFR 149.610, a provider must give an uninsured or self-pay individual a good faith estimate on request or on scheduling, and when the estimate is requested by the patient it is due within 3 business days. That works for a scheduled follow-up or a planned scar revision; it does not produce a number while a walk-in patient waits. The good faith estimate guide covers the dispute rights that come with one.

After an emergency visit, the work happens once the bills arrive. Ask the hospital for an itemized statement with codes, compare the repair line's length band with the length in the record, and ask about the hospital's financial assistance policy. Our guides to hospital financial assistance and negotiating a hospital bill use the Medicare anchor as a reference point in that conversation, not as a price the hospital owes you.

With insurance, the anchor gives way to the plan's contracted rate, and the deductible and coinsurance apply line by line on each claim. For an emergency visit at an out-of-network hospital, the federal emergency protections described in our No Surprises Act guide change what the plan may charge you, and the choice between the two settings is laid out on urgent care versus the emergency room.

Glue, strips and staples are billed differently

Not every closure is sutured, and the coding rules split by method. The NCCI policy manual, chapter III, says payment for a surgical procedure includes dressings, supplies and local anesthesia, which are not separately reportable. Closures with adhesive strips or tape alone are not separately reportable either; without another procedure, they are included in the visit code.

Tissue adhesive alone is treated differently. A practitioner who closes a wound with tissue adhesive only may report HCPCS G0168. Its CY2026 Michigan Locality 01 anchors are $103.89 non-facility and $15.57 facility, with a 0-day global period. If adhesive is used together with sutures or staples, the manual says G0168 is not separately reportable and the closure is billed as the repair.

The hospital side runs on a different code list. The same manual says the hospital outpatient system does not recognize or pay G0168, which matches its status B in Addendum B, and that facilities report closures with sutures, staples or tissue adhesive, singly or combined, using the repair codes. So a glued 2 cm forearm cut in an emergency department can show G0168 on the physician's bill and 12001 on the hospital's. Two different codes for one closure is the rule working as written, not an error.

Staples carry no code of their own in these files. A stapled closure is billed with the repair code for its length, type and body area, the same as a sutured one.

Follow-up visits and the global period

The claims manual, chapter 12, section 40.1, defines what a surgical payment already includes when the same physician provides it. The list covers postoperative visits related to recovery during the postoperative period, local incisional care, dressing changes, and removal of cutaneous sutures and staples. It applies in any setting, including offices and hospitals.

What that means for a wound repair depends on the global period. Intermediate and complex repairs carry 10 days in the RVU file, so a recovery-related visit with the same physician in those 10 days is already paid for inside the repair. Simple repairs carry 0 days, so the fee schedule builds no postoperative days into their payment, and a later visit for the same wound sits outside the repair's global package. The manual's list of excluded services also names visits unrelated to the diagnosis behind the procedure, which can be billed during the period with modifier 24 under the NCCI manual.

Two practical consequences follow for the bill. A clinic that repaired a cut with 12034 and later bills a visit for a routine check of that same wound inside 10 days has billed a service the repair already covers, at least under Medicare rules. And a patient who returns to a different clinic for suture removal is outside the first physician's package entirely, because the global package covers services by the physician who did the surgery. Ask either clinic, before the visit, whether it will bill the follow-up and under which code. The guide to the follow-up visit after surgery and the global period extends the 10-day rule to 0-day and 90-day operations, with the modifiers a legitimate separate visit carries.

Stitches billing questions, by length and repair type

The RVU file, OPPS addenda and manuals cited

• CMS, Physician Fee Schedule relative value file RVU26D (October 2026 release, PPRRVU2026_Oct_nonQPP, released 08/26/2026) and GPCI2026, Michigan Locality 01 (work 1.000, practice expense 0.965, malpractice 1.686), CY2026 conversion factor $33.4009: every PFS non-facility and facility anchor, work RVU, global period and multiple procedure indicator for 12001 to 12037, 13100 to 13122 and G0168. Computed October 31, 2026; stored in src/data/wound-repair-anchors-2026.json.
• CMS, OPPS October 2026 Addendum B (file dated 10/14/2026): status indicators, APCs, national unadjusted payments and minimum unadjusted copayments for the wound repair codes, G0168, G0463 and 99281 to 99285. Checked October 31, 2026.
• CMS, CY2026 OPPS final rule addenda, Addendum D1: definitions of status indicators B, J2, N, Q1, Q2 and T. Checked October 31, 2026.
• CMS, NCCI Policy Manual for Medicare Services, chapter III, Integumentary System, revision date 1/1/2026: section B (visits on the day of a minor procedure, modifiers 25 and 24) and the repair section (supplies and local anesthesia included, adhesive strips, G0168, closures under the hospital outpatient system). Checked October 31, 2026.
• CMS, Medicare Claims Processing Manual, chapter 12 (Rev. 13753, issued 05-07-26): section 20.4.2 (site of service payment differential and place of service lists), section 40.1 (global surgical package) and section 40.6 (multiple surgeries). Checked October 31, 2026.
• eCFR, 45 CFR 149.610, good faith estimates for uninsured or self-pay individuals, timing of the estimate. Checked October 31, 2026.
• Medicare.gov, Medicare costs, 2026 Part B deductible of $283.00. Checked October 30, 2026.

General billing information, not medical, legal or insurance advice. CPT codes and descriptors are copyright the American Medical Association; descriptors here are plain-language paraphrases. Medicare anchors are not your bill. Confirm your price in writing before service.