Cmplx rpr e/n/e/l 1.1-2.5 cm
Complex eyelid, nose, ear, or lip repair procedures (1.1-2.5 cm) show a potential difference of $378 depending on care setting, making bill verification essential before treatment.
About the analyst
Elena Vasquez leads hospital billing pattern analysis at BillRazor Research. She focuses on identifying overcharges, markup outliers, and patient advocacy strategies. Expertise: hospital billing patterns, overcharge analysis, patient advocacy.
Complex repair code 13151 covers surgical closure of wounds measuring 1.1 to 2.5 centimeters on the face, requiring layered suturing techniques for areas like eyelids, nose, ears, or lips. Patients typically receive this after trauma, skin cancer removal, or other facial injuries requiring precise reconstruction. This procedure charges approximately 8-12x the Medicare reimbursement rate depending on the facility type and geographic location.
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Facility rate
$234
National Medicare benchmark
Non-facility rate
$99
Office setting benchmark
Data sources
4
24 data points
Key insights for CPT 13151
ASC vs hospital outpatient savings
$284Having this done at an ambulatory surgery center costs $328 vs $612 at a hospital outpatient
Facility vs office setting
$135 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) | $234 | +137% |
| Non-facility (office) | $99 | Lowest |
| Outpatient (APC) | $612 | +518% |
| Ambulatory surgery (ASC) | $328 | +232% |
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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