Cmplx rpr f/c/c/m/n/ax/g/h/f
Complex repair procedures for facial, chest, or other body areas show facility rates ranging from $205 to $400, making it essential to verify your specific charges against these Medicare benchmarks.
About the analyst
Kevin Nyk analyzes hospital pricing data at BillRazor Research. He specializes in Medicare reimbursement patterns and chargemaster pricing across U.S. hospitals. Expertise: hospital pricing, Medicare rates, chargemaster analysis.
Code 13131 covers complex wound repair requiring layered closure on the face, chin, chest, mouth, nose, underarm, genitals, hands, or feet. Patients typically need this after accidents, surgical procedures, or trauma resulting in deep lacerations in these sensitive areas. This procedure charges approximately 12.8x the Medicare reimbursement rate of $421, with potential billing differences of $2,100 depending on the healthcare facility.
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Facility rate
$205
National Medicare benchmark
Non-facility rate
$99
Office setting benchmark
Data sources
4
24 data points
Key insights for CPT 13131
ASC vs hospital outpatient savings
$185Having this done at an ambulatory surgery center costs $214 vs $400 at a hospital outpatient
Facility vs office setting
$106 differenceNon-facility setting is less expensive for this procedure
What this procedure costs across different settings
The same procedure can cost very different amounts depending on where it's performed. These are the Medicare-allowed amounts — what hospitals actually charge can be 3-10x higher.
| Setting | Medicare rate | vs lowest |
|---|---|---|
| Facility (physician office) | $205 | +107% |
| Non-facility (office) | $99 | Lowest |
| Outpatient (APC) | $400 | +304% |
| Ambulatory surgery (ASC) | $214 | +117% |
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About this data
Rates shown are from the 2026 Medicare Physician Fee Schedule, Hospital Outpatient Prospective Payment System (OPPS), Ambulatory Surgery Center Payment System, Clinical Laboratory Fee Schedule, Durable Medical Equipment Fee Schedule, and CMS Inpatient Prospective Payment System (DRG weights). Regional adjustments use CMS Geographic Practice Cost Indices (GPCI). Hospital charges are from CMS Hospital Price Transparency machine-readable files. All data is publicly available under federal law (45 CFR Part 180).
This data is for informational purposes only and does not constitute medical or financial advice. Actual costs depend on insurance coverage, negotiated rates, and individual circumstances.
Data: Medicare Physician Fee Schedule, CMS Inpatient PPS (IPPS), Outpatient PPS (OPPS), ASC Payment System, Clinical Lab Fee Schedule (CLFS), National Average Drug Acquisition Cost (NADAC). FY 2024 data. All publicly available from CMS.
Methodology: Facility rate applies when the procedure is performed in a hospital or ASC. Non-facility rate applies in a physician office. GPCI adjustments reflect regional cost-of-living differences.
This information is for educational purposes only and is not medical, financial, or legal advice. Actual costs depend on your insurance and provider. We recommend verifying costs directly with your provider. Full methodology · Terms of use