CPT® Code 12020

CPT Assistant Articles
Additional Code Info
Anatomy/Physiology Online
Dictionary Definitions Illustrations
My Notes
Alerts

Newsletters
Coding Tips
Fees - Facility
Fees - Non-Facility
RVUs - Facility: Show Details
RVUs - Non-Facility: Show Details

Cross-A-Code
NCCI Edits - Facility
NCCI Edits - Non-Facility
Medicare Policies & Guidelines
PQRS

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Code History

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Anatomy & Physiology Online for Coders

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Click on a link to view the following terms in Anatomy & Physiology Online for Coders.

Anatomical Language

Anatomical directions: Superficial

Case studies

Wound infection (Case study)

Epithelium

Skin: sebaceous glands (3D view)

General Functions of the Skin

Skin (3D view)

Glands

Skin: merocrine sweat gland (3D view)

Innate Immunity

Skin (3D view)
Tissue repair

Joints

Suture
Suture (3D view)

Other Endocrine Glands and Tissues

Skin

Skull

Sutures

Tissue Repair

Tissue repair
Tissue repair (Topic)
Tissue repair: connective tissue
Tissue repair: epithelium
Tissue repair: muscle tissue
Tissue repair: nervous tissue

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My Notes

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Coding Tips

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Fees

Calculated for UT (84043)

* Note: Medicare may or may NOT reimburse you for this code. The fees provided below are based on values established by CMS/Medicare. Please check with your local Medicare contact on whether this code is eligible for reimbursement.

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Facility (Hospital, etc.)

Modifier	Medicare Allowed	150%	200%	My Fee
(none)	$185.75	$278.62	$371.50	(your fee)

Modifier	Allowed	Medicare 80%	Patient Pays
(none)	$185.75	$##.##	$##.##

Modifier	Allowed	Medicare 80%	Patient Pays	Limiting Charge (Amount Billed)
(none)	$##.##	$##.##	$##.##	$##.##

Modifier	Allowed	Medicare 80%	Patient Pays	Limiting Charge (Amount Billed)
(none)	$##.##	$##.##	$##.##	$##.##

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Non-Facility (Office, etc.)

Modifier	Medicare Allowed	150%	200%	My Fee
(none)	$274.26	$411.39	$548.51	(your fee)

Modifier	Allowed	Medicare 80%	Patient Pays
(none)	$274.26	$##.##	$##.##

Modifier	Allowed	Medicare 80%	Patient Pays	Limiting Charge (Amount Billed)
(none)	$##.##	$##.##	$##.##	$##.##

Modifier	Allowed	Medicare 80%	Patient Pays	Limiting Charge (Amount Billed)
(none)	$##.##	$##.##	$##.##	$##.##

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APC Fee Information

Note: APC information, including Status Indicator, Relative Weight, Payment Rate, Crosswalks, and more, is available to Subscribers with the Hospital/Facility product.

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RVUs - Relative Value Units

Calculated for UT (84043)

* Note: Medicare may or may NOT reimburse you for this code. The fees provided below are based on values established by CMS/Medicare. Please check with your local Medicare contact on whether this code is eligible for reimbursement.

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Facility 5.46 (Hospital, etc.)

RVU Components (by modifier)

Modifier	Work	Practice Expense	Malpractice Expense	Total
(none)	2.67	2.33	0.46	5.46

Note: Subscribers with the Hospital/Facility product will see calculated values below.

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Practitioner Work Component: 2.67

Pre-Service	Intra-Service	Post-Service	Total Time*
##	##	##	## min

Modifier	National Unadjusted Work RVU	Work GPCI	Adjusted Work RVU
(none)	##.##	##.##	2.67

Practice Expense: 2.33

Clinical Labor - Direct Expense

Staff	Staff Rate	Pre Time	Intra Time	Post Time	Total Time*
RN/LPN/MTA	.37 / min	## min	## min	## min	## min

* Total Time may be greater than the displayed components.

Equipment - Direct Expense

Item	Purchase Price	Expected Life	Total Time
light, surgical	$##.##	## years	## min
mayo stand	$##.##	## years	## min
table, power	$##.##	## years	## min
electrocautery-hyfrecator, up to 45 watts	$##.##	## years	## min
instrument pack, basic (0-99)	$##.##	## years	## min
light, exam	$##.##	## years	## min

Supplies - Direct Expense

Item	Unit Price	Quantity	Unit	Amount
pack, cleaning, surgical instruments	$##.##	##	pack	$##.##
pack, minimum multi-specialty visit	$##.##	##	pack	$##.##
pack, post-op incision care (suture)	$##.##	##	pack	$##.##
pack, drapes, ortho, small	$##.##	##	pack	$##.##
pack, protective, ortho, small	$##.##	##	pack	$##.##
drape-cover, sterile, OR light handle	$##.##	##	item	$##.##
needle, 18-27g	$##.##	##	item	$##.##
syringe 10-12ml	$##.##	##	item	$##.##
cautery, monopolar, pencil-handpiece	$##.##	##	item	$##.##
cautery, patient ground pad w-cord	$##.##	##	item	$##.##
scalpel with blade, surgical (#10-20)	$##.##	##	item	$##.##
suture, nylon, 4-0 to 6-0, p, ps	$##.##	##	item	$##.##
suture, vicryl, 3-0 to 6-0, p, ps	$##.##	##	item	$##.##
gauze, sterile 4in x 4in (10 pack uou)	$##.##	##	item	$##.##
tape, surgical paper 1in (Micropore)	$##.##	##	inch	$##.##
lidocaine 1%-2% inj (Xylocaine)	$##.##	##	ml	$##.##
sodium chloride 0.9% irrigation (500-1000ml uou)	$##.##	##	item	$##.##
basin, irrigation	$##.##	##	item	$##.##
bulb syringe (Asepto)	$##.##	##	item	$##.##
povidone soln (Betadine)	$##.##	##	ml	$##.##
tubed culture media	$##.##	##	item	$##.##

Indirect Expenses (clerical,overhead, and other) are also included in the practice expense.

PE RVU Components (by modifier)

Modifier	National Unadjusted PE RVU	PE GPCI	Adjusted PE RVU
(none)	##.##	##.##	2.33

Malpractice Component: 0.46

Modifier	National Unadjusted MP RVU	MP GPCI	Adjusted MP RVU
(none)	##.##	##.##	0.46

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Non-Facility 8.06 (Office, etc.)

RVU Components (by modifier)

Modifier	Work	Practice Expense	Malpractice Expense	Total
(none)	2.67	4.93	0.46	8.06

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Practitioner Work Component: 2.67

Pre-Service	Intra-Service	Post-Service	Total Time*
##	##	##	## min

Modifier	National Unadjusted Work RVU	Work GPCI	Adjusted Work RVU
(none)	##.##	##.##	2.67

Practice Expense: 4.93

Clinical Labor (Non-Facility)- Direct Expense

Staff	Staff Rate	Pre Time	Intra Time	Post Time	Total Time*
RN/LPN/MTA	.37 / min	## min	## min	## min	## min

* Total Time may be greater than the displayed components.

Equipment (Non-Facility)- Direct Expense

Item	Purchase Price	Expected Life	Total Time
light, surgical	$##.##	## years	## min
mayo stand	$##.##	## years	## min
table, power	$##.##	## years	## min
electrocautery-hyfrecator, up to 45 watts	$##.##	## years	## min
instrument pack, basic (0-99)	$##.##	## years	## min
light, exam	$##.##	## years	## min

Supplies (Non-Facility)- Direct Expense

Item	Unit Price	Quantity	Unit	Amount
pack, cleaning, surgical instruments	$##.##	##	pack	$##.##
pack, minimum multi-specialty visit	$##.##	##	pack	$##.##
pack, post-op incision care (suture)	$##.##	##	pack	$##.##
pack, drapes, ortho, small	$##.##	##	pack	$##.##
pack, protective, ortho, small	$##.##	##	pack	$##.##
drape-cover, sterile, OR light handle	$##.##	##	item	$##.##
needle, 18-27g	$##.##	##	item	$##.##
syringe 10-12ml	$##.##	##	item	$##.##
cautery, monopolar, pencil-handpiece	$##.##	##	item	$##.##
cautery, patient ground pad w-cord	$##.##	##	item	$##.##
scalpel with blade, surgical (#10-20)	$##.##	##	item	$##.##
suture, nylon, 4-0 to 6-0, p, ps	$##.##	##	item	$##.##
suture, vicryl, 3-0 to 6-0, p, ps	$##.##	##	item	$##.##
gauze, sterile 4in x 4in (10 pack uou)	$##.##	##	item	$##.##
tape, surgical paper 1in (Micropore)	$##.##	##	inch	$##.##
lidocaine 1%-2% inj (Xylocaine)	$##.##	##	ml	$##.##
sodium chloride 0.9% irrigation (500-1000ml uou)	$##.##	##	item	$##.##
basin, irrigation	$##.##	##	item	$##.##
bulb syringe (Asepto)	$##.##	##	item	$##.##
povidone soln (Betadine)	$##.##	##	ml	$##.##
tubed culture media	$##.##	##	item	$##.##

Indirect Expenses (clerical,overhead, and other) are also included in the practice expense.

PE RVU Components (by modifier)

Modifier	National Unadjusted PE RVU	PE GPCI	Adjusted PE RVU
(none)	##.##	##.##	4.93

Malpractice Component: 0.46

Modifier	National Unadjusted MP RVU	MP GPCI	Adjusted MP RVU
(none)	##.##	##.##	0.46

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Cross-A-Code™ (ICD-9, CPT, HCPCS, Modifiers, ASA CROSSWALK^®)

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Medicare Policies & Guidelines

Subscribers may see Crosswalks here for Local Coverage Determinations (LCDs) or Ambulatory Patient Classifications (APCs) with information on covered diagnosis and procedure codes.

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Physician Quality Reporting System (PQRS)

PQRS is a program where an incentive payment is made to professionals who report data on various measures.
Learn more about PQRS or Read about PQRS at cms.gov.

This code (12020) is not used with any individual PQRS measures.

Anatomical Language

Case studies

Epithelium

General Functions of the Skin

Glands

Innate Immunity

Joints

Other Endocrine Glands and Tissues

Skull

Tissue Repair

AHA Coding Clinic® for HCPCS

AHA Coding Clinic^® for HCPCS