CPT 12031 Surgery - Integumentary

How Much Does Intermediate Repair of S/a/t/extremity 2.5 Cm/< Cost?

Also known as: Intmd rpr s/a/t/ext 2.5 cm/< (CPT 12031)

Intermediate wound repair on the body or extremities, 2.5 cm or less.

The total estimated cost of Intermediate Repair of S/a/t/extremity 2.5 Cm/< (CPT 12031) is $320 to $520, including hospital fees, anesthesia, and supplies. The surgeon's Medicare fee alone is $133.

Total Estimated Cost of Care

$320 — $520

This estimate includes hospital facility fees, anesthesia, and supplies .

Surgeon/Physician Fee
$133
Hospital Facility Fee
$267
Important: The physician fee of $133 shown in the cost cards below is what Medicare pays the surgeon/doctor only. The hospital charges a separate facility fee that typically makes up 70-85% of the total cost.
Medicare Physician Fee (Facility Setting)
$133
Physician component only — CMS PFS 2026
Medicare Physician Fee (Office/Clinic)
$260
Non-facility setting

Patient Guide: Intermediate Repair of S/a/t/extremity 2.5 Cm/<

What you need to know before your appointment

What to Expect

The doctor closes a wound in layers (deeper tissue first, then skin) for a wound on the body, arms, or legs.

How Long Does It Take?

20-30 minutes

Common Reasons Doctors Order This

Deep laceration on the body or extremities, wound involving deeper tissue layers

How to Prepare

Apply pressure to bleeding. These wounds require layered closure for proper healing.

Procedures Commonly Done Together

These procedures are frequently performed alongside Intmd rpr s/a/t/ext 2.5 cm/<

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What Insurance Companies Actually Pay

Real negotiated rates from 15 hospitals across 6 states (from hospital price transparency filings)

Lowest
$0
Highest
$5,841
Average
$1,301
Insurance Company Avg Rate Range Hospitals
Aetna $1,942 $89 - $4,833 10
United $1,233 $154 - $2,749 10
Cigna $1,387 $0 - $3,244 9
Humana $2,042 $170 - $4,690 8
BCBS $1,207 $150 - $2,312 5
Superior Health Plan $926 $600 - $948 4
KAISER FOUNDATION HEALTH PLAN, INC. $834 $483 - $1,512 5
BCBS-TX $226 $121 - $310 2
Wellpoint $287 $143 - $600 2
CHC $1,155 $158 - $2,335 2
Molina Healthcare $157 $157 2
Community Health Choice MCD $160 $160 2
Average by State
KY: $377 (21) GA: $476 (31) TN: $535 (24) CA: $834 (15) TX: $1,444 (264) CO: $2,259 (34)
Disclaimer: These rates are from hospital Machine-Readable Files (MRFs) required by federal price transparency law. They reflect specific hospital-payer contracts and may not represent your actual cost, which depends on your plan, deductible, and network status. Data sourced from CommonSpirit Health, HCA Healthcare, and Kaiser Permanente filings.

How to Reduce Your Cost for Intmd rpr s/a/t/ext 2.5 cm/<

Practical tips that can save you hundreds or thousands of dollars

  • 1
    Ask about cash-pay discounts

    Many hospitals and clinics offer 20-40% discounts for self-pay patients. Always ask before scheduling.

  • 2
    Compare facility vs. office setting costs

    For this procedure, the office rate ($260) differs from the facility rate ($133). Ask if it can be done in an office setting.

  • 3
    Shop around — costs vary significantly

    Costs can vary 2-3x between providers in the same city. Get quotes from multiple facilities.

How is the Price Calculated?

Medicare calculates procedure payments using Relative Value Units (RVUs). Each procedure has three components multiplied by a conversion factor ($33.40 in 2026) and adjusted by geographic cost indices.

1.95
Work RVU
1.81
Practice Expense RVU
0.23
Malpractice RVU
7.78
Total RVU

Payment = Total RVU (7.78) x CF ($33.40) = $260

People Also Ask

Common questions people search for about this procedure

How expensive are stitches at ER?

Average cost to get stitches Getting stitches at an emergency room costs much more, with prices ranging from 00 to ,500+ for patients with insurance and ,500 to ,000+ for those without insurance. Get free estimates from urgent care near you.

Source: bettercare.com See our data-backed answer →
How much do stitches normally cost?

Most patients should expect to pay anywhere from 00-00 for the procedure, contingent on the complexity of the wound and their insurance.

Source: insighturgentcaretx.com See our data-backed answer →
Can I go to the ER for stitches?

Cuts that may require stitches at an emergency room: Deep cuts: Cuts that are deep, extending to tendons may require evaluation and treatment at an emergency room. Deep cuts can result in significant bleeding, damage to muscles, nerves, or tendons, or pose a risk of infection.

Source: completehealthpartners.com See our data-backed answer →
What are common ER hidden fees?

Typical charges you might see on your ER bill Professional fees to cover services provided by doctors, nurse practitioners and other medical providers who treat and care for you. Medications, equipment or supplies used. Charges for lab tests or X-rays.

Source: www.healthpartners.com See our data-backed answer →

Frequently Asked Questions

How much does Intmd rpr s/a/t/ext 2.5 cm/< cost?

The Medicare facility rate for Intmd rpr s/a/t/ext 2.5 cm/< is $133. Commercial insurance rates typically range from 150% to 250% of Medicare (varies by plan).

How much does Intmd rpr s/a/t/ext 2.5 cm/< cost without insurance?

Without insurance, the cost of Intmd rpr s/a/t/ext 2.5 cm/< can range from 150% of Medicare to 500% of Medicare depending on the facility. Many hospitals and clinics offer self-pay discounts of 20-40% off their chargemaster price. Always ask about cash pricing before your visit.

Does insurance cover Intmd rpr s/a/t/ext 2.5 cm/<?

Most commercial health insurance plans and Medicare cover Intmd rpr s/a/t/ext 2.5 cm/< when ordered by a physician for a medically necessary reason. Your out-of-pocket cost depends on your plan's deductible, copay/coinsurance structure, and whether you use an in-network provider. Check with your insurance company before scheduling to confirm coverage and get a cost estimate.

Why does the cost vary so much by location?

Medicare adjusts payments using Geographic Practice Cost Indices (GPCIs) that reflect local differences in physician work costs, practice expenses, and malpractice insurance. Manhattan, San Francisco, and other high-cost areas pay significantly more than rural regions. Commercial insurers follow similar geographic patterns.

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