12035

Intermediate repair of wounds on the scalp, axillae, trunk, or extremities (excluding hands and feet), measuring 12.6 to 20.0 cm in total length.

Verified May 8, 2026 · 7 sources ↓

Medicare: $414.17
Total RVUs: 12.4
Global, days: 10
Region: General

Drawn from AAPCCMSHiacodeMdclarity

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 7 cited references ↓

Wound classification documented as intermediate — specify layered closure or note heavy contamination requiring extensive cleansing/debridement
Anatomic location confirmed as scalp, axillae, trunk, or extremity, with explicit statement that the wound is NOT on the hand or foot
Total wound length in centimeters — if multiple wounds are added together, document each individual length and the summed total
Closure method documented (sutures, staples, tissue adhesive, or combination), including layer detail for layered closures
If billing alongside a major surgical procedure, document that the wound is separate from and not contiguous with the surgical incision, with distinct site description

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 25 Significant separate E/M 51 Multiple procedures 52 Reduced services 59 Distinct service 79 Unrelated during global 80 Assistant surgeon XS Separate structure

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 12035 covers intermediate-complexity wound closure on the scalp, axillae, trunk, or extremities — hands and feet are explicitly excluded. Intermediate repair means the wound required layered closure, or was single-layer but heavily contaminated requiring extensive cleansing or removal of particulate matter. The 12.6–20.0 cm length threshold is the total combined length of all intermediate repairs within this anatomic grouping; wounds from the same classification and anatomic group are summed, not billed separately.

When multiple wound repairs are performed in a single session, add together lengths only within the same repair classification and the same anatomic grouping as defined in the code descriptors. If more than one classification is repaired (e.g., both intermediate and complex), the more complex repair is the primary procedure. Simple and intermediate repairs are bundled into repairs of nerves, blood vessels, and tendons — do not bill 12035 alongside those codes for the same wound.

NCCI bundles 12035 as a Column Two code under surgical procedures that include incision closure as a standard component (e.g., CPT 47600 cholecystectomy includes closure of its own incision). If a separate, distinct wound exists at a different anatomic site from the surgical incision, 12035 may be separately reportable using an NCCI PTP-associated modifier. Document the separate wound's location, etiology, and measurements explicitly to support that bypass.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	3.41
Practice expense RVU	8.37
Malpractice RVU	0.62
Total RVU	12.4
Medicare national rate	$414.17
Global period	10 days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$414.17
HOPD (APC 5052) Hospital outpatient department	$415.32
ASC (PI A2) Ambulatory surgical center (freestanding)	$223.01

Common denial reasons

The recurring reasons claims for CPT 12035 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Bundled into the primary surgical procedure's global incision closure — no separate site documented to support NCCI modifier bypass
Length falls outside 12.6–20.0 cm range due to incorrect summation across different anatomic groups or different repair classifications
Wound location listed as hand or foot, which are explicitly excluded from this code's anatomic grouping
Repair complexity not supported — documentation describes single-layer closure of a clean wound without evidence of contamination or layered technique
Repair billed separately when performed on the same wound as a nerve, blood vessel, or tendon repair — intermediate repairs are bundled into those procedures

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01Can I bill 12035 for a wound on the forearm?

Yes. The forearm is part of the extremities grouping covered by 12035. Hands and feet are the only extremity locations excluded. Document 'forearm' specifically — vague terms like 'upper limb' invite audits.

02How do I calculate total wound length when a patient has multiple lacerations on the trunk?

Add together the lengths of all intermediate repairs within the same anatomic grouping. Two trunk lacerations of 7.0 cm and 6.0 cm each sum to 13.0 cm — report as a single unit of 12035. Do not add a scalp wound length to a trunk wound length; those are separate groupings.

03Is 12035 billable the same day as a major orthopedic procedure?

Only if the wound being repaired is distinct from and not part of the surgical incision. The NCCI bundles 12035 into Column One surgical codes that include standard incision closure. A traumatic wound at a completely separate anatomic site, documented as such, supports using modifier 59 or XS to bypass the edit.

04What's the global period for 12035?

10-day global. Routine wound checks and suture removal within those 10 days are included and not separately billable. An unrelated E/M service during that window requires modifier 24.

05When does a single-layer closure qualify as intermediate rather than simple?

Single-layer closure qualifies as intermediate when the wound is heavily contaminated and required extensive cleansing or removal of particulate matter before closure. Document the contamination, the cleansing performed, and the time or effort involved — 'wound irrigated and debris removed' is not enough; be specific about the extent.

06Can I bill 12035 alongside a nerve repair code for the same wound?

No. Simple and intermediate wound repairs are bundled into nerve, blood vessel, and tendon repair codes. Do not separately bill 12035 for closure of the same wound where a nerve repair was performed. Complex wound repairs (13000 series) can be separately reported with modifier 59.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

Mira's AI scribe captures wound location (scalp, axilla, trunk, or extremity with explicit exclusion of hand/foot), closure technique layer by layer, individual wound measurements in centimeters, and contamination status from dictation. That detail directly prevents the two most common denials: bundling into a concurrent surgical procedure's incision closure, and length miscalculation from grouping wounds across incompatible anatomic categories.

See how Mira captures CPT 12035 documentation