CPT 12016 Surgery - Integumentary

How Much Does Repair of Fe/e/en/l/m 12.6-20.0 Cm Cost?

Also known as: Rpr fe/e/en/l/m 12.6-20.0 cm (CPT 12016)

Simple wound repair on face/ears/eyelids/nose/lips, 12.6 to 20.0 cm.

The total estimated cost of Repair of Fe/e/en/l/m 12.6-20.0 Cm (CPT 12016) is $293 to $477, including hospital fees, anesthesia, and supplies. The surgeon's Medicare fee alone is $122.

Total Estimated Cost of Care

$293 — $477

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

Surgeon/Physician Fee
$122
Hospital Facility Fee
$245
Important: The physician fee of $122 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)
$122
Physician component only — CMS PFS 2026
Medicare Physician Fee (Office/Clinic)
$268
Non-facility setting

Patient Guide: Repair of Fe/e/en/l/m 12.6-20.0 Cm

What you need to know before your appointment

What to Expect

Extensive careful closure of a large facial wound.

How Long Does It Take?

30-45 minutes

Common Reasons Doctors Order This

Large facial wound from trauma

How to Prepare

Multiple follow-ups may be needed. Sun protection is essential.

Procedures Commonly Done Together

These procedures are frequently performed alongside Rpr fe/e/en/l/m 12.6-20.0 cm

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How to Reduce Your Cost for Rpr fe/e/en/l/m 12.6-20.0 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 ($268) differs from the facility rate ($122). 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.

2.61
Work RVU
0.44
Practice Expense RVU
0.61
Malpractice RVU
8.01
Total RVU

Payment = Total RVU (8.01) x CF ($33.40) = $268

Frequently Asked Questions

How much does Rpr fe/e/en/l/m 12.6-20.0 cm cost?

The Medicare facility rate for Rpr fe/e/en/l/m 12.6-20.0 cm is $122. Commercial insurance rates typically range from 150% to 250% of Medicare (varies by plan).

How much does Rpr fe/e/en/l/m 12.6-20.0 cm cost without insurance?

Without insurance, the cost of Rpr fe/e/en/l/m 12.6-20.0 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 Rpr fe/e/en/l/m 12.6-20.0 cm?

Most commercial health insurance plans and Medicare cover Rpr fe/e/en/l/m 12.6-20.0 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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