CPT code 12054: Wound repair, face, 7.6–12.5 cm2026 Medicare rate & RVUs in West Virginia
Report this code for intermediate repair of qualifying facial or mucosal wounds when the combined repaired length falls within the 7.6–12.5 cm range.
In West Virginia, Medicare pays $364.67 for 12054 in the office and $195.74 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 12054 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What 12054 covers
This code covers an intermediate repair on the face or mucous membranes, including sites such as the eyelid, nose, lip, or ear. The repair involves layered closure, including deeper tissue beneath the skin, or a single-layer closure when a heavily contaminated wound requires extensive cleaning. Physicians and other qualified clinicians commonly perform these repairs in emergency departments, offices, and outpatient surgical settings.
Select the code using the total repaired length of qualifying wounds in the same anatomic grouping and repair classification; documentation should identify the sites, measurements, wound characteristics, and closure performed. The code has a 10-day global period, so related postoperative visits during that period are included. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery, and co-surgeons and team surgery are not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
How West Virginia compares for 12054
Across 109 of 109 payment localities, the office rate for 12054 runs from $346.46 in Arkansas to $511.24 in San Benito County, CA. West Virginia pays $364.67. The RVUs are the same everywhere; the geographic indexes change the dollars.
- West Virginia · this page$364.67
- Los Angeles, CA · California$438.08+$73.41
- Washington, DC area · District of Columbia$445.91+$81.24
- Miami, FL · Florida$428.19+$63.52
- Chicago, IL · Illinois$415.62+$50.95
- Manhattan, NY · New York$450.94+$86.27
- Alaska · Alaska$457.69+$93.02
Other areas in West Virginia first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $351.50 | $181.41 |
| ArkansasArkansas | $346.46 | $179.48 |
| ArizonaArizona | $380.93 | $192.56 |
| Bakersfield, CACalifornia | $411.97 | $198.92 |
| Chico, CACalifornia | $410.50 | $197.45 |
| El Centro, CACalifornia | $410.59 | $197.53 |
| Fresno, CACalifornia | $410.50 | $197.45 |
| Hanford, CACalifornia | $410.50 | $197.45 |
| Madera, CACalifornia | $410.50 | $197.45 |
| Merced, CACalifornia | $410.50 | $197.45 |
| Modesto, CACalifornia | $410.50 | $197.45 |
| Napa, CACalifornia | $473.10 | $216.89 |
| Oxnard, CACalifornia | $435.64 | $205.87 |
| Redding, CACalifornia | $410.50 | $197.45 |
| Rest of CaliforniaCalifornia | $410.50 | $197.45 |
| Riverside, CACalifornia | $416.02 | $202.96 |
| Sacramento, CACalifornia | $430.12 | $204.04 |
| Salinas, CACalifornia | $428.51 | $203.21 |
| San Diego, CACalifornia | $438.14 | $205.64 |
| Marin County, CACalifornia | $499.88 | $225.78 |
| San Francisco, CACalifornia | $499.30 | $225.21 |
| San Benito County, CACalifornia | $511.24 | $230.92 |
| Santa Clara County, CACalifornia | $508.87 | $228.55 |
| San Luis Obispo, CACalifornia | $421.70 | $200.29 |
| Santa Cruz, CACalifornia | $441.96 | $205.77 |
| Santa Maria, CACalifornia | $429.99 | $203.33 |
| Santa Rosa, CACalifornia | $446.37 | $207.66 |
| Stockton, CACalifornia | $410.50 | $197.45 |
| Vallejo, CACalifornia | $472.27 | $216.06 |
| Visalia, CACalifornia | $410.50 | $197.45 |
| Yuba City, CACalifornia | $410.50 | $197.45 |
| ColoradoColorado | $405.77 | $198.93 |
| ConnecticutConnecticut | $417.37 | $208.01 |
| DelawareDelaware | $387.18 | $195.12 |
| Fort Lauderdale, FLFlorida | $408.61 | $211.69 |
| Rest of FloridaFlorida | $388.56 | $202.72 |
| Atlanta, GAGeorgia | $399.39 | $201.89 |
| Rest of GeorgiaGeorgia | $366.59 | $193.19 |
| Hawaii, Guam, HIHawaii | $419.98 | $198.95 |
| IowaIowa | $359.04 | $181.17 |
| IdahoIdaho | $361.64 | $182.80 |
| East St. Louis, ILIllinois | $387.89 | $209.05 |
| Rest of IllinoisIllinois | $378.38 | $200.90 |
| Suburban Chicago, ILIllinois | $412.44 | $212.80 |
| IndianaIndiana | $363.68 | $183.48 |
| KansasKansas | $358.00 | $182.27 |
| KentuckyKentucky | $361.09 | $188.28 |
| New Orleans, LALouisiana | $378.40 | $195.48 |
| Rest of LouisianaLouisiana | $360.78 | $188.74 |
| Metropolitan Boston, MAMassachusetts | $444.80 | $212.69 |
| Rest of MassachusettsMassachusetts | $403.63 | $198.93 |
| Baltimore area, MDMaryland | $416.34 | $207.75 |
| Rest of MarylandMaryland | $394.33 | $197.60 |
| Rest of MaineMaine | $364.18 | $185.34 |
| Southern Maine, MEMaine | $382.83 | $190.18 |
| Detroit, MIMichigan | $394.03 | $206.44 |
| Rest of MichiganMichigan | $370.99 | $193.51 |
| MinnesotaMinnesota | $387.02 | $186.99 |
| Metropolitan Kansas City, MOMissouri | $375.17 | $192.64 |
| Metropolitan St. Louis, MOMissouri | $378.99 | $193.92 |
| Rest of MissouriMissouri | $355.06 | $187.50 |
| MississippiMississippi | $350.80 | $183.43 |
| MontanaMontana | $391.42 | $197.03 |
| North CarolinaNorth Carolina | $367.85 | $186.48 |
| North DakotaNorth Dakota | $381.34 | $186.95 |
| NebraskaNebraska | $360.80 | $181.38 |
| New HampshireNew Hampshire | $400.01 | $197.65 |
| Northern New JerseyNew Jersey | $441.48 | $215.98 |
| Rest of New JerseyNew Jersey | $421.64 | $209.36 |
| New MexicoNew Mexico | $373.26 | $195.00 |
| NevadaNevada | $388.87 | $194.29 |
| NYC suburbs and Long Island, NYNew York | $462.59 | $231.45 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $424.91 | $212.05 |
| Queens, NYNew York | $453.69 | $223.92 |
| Rest of New YorkNew York | $373.37 | $188.70 |
| OhioOhio | $368.93 | $191.45 |
| OklahomaOklahoma | $359.78 | $186.19 |
| Portland, OROregon | $417.84 | $201.87 |
| Rest of OregonOregon | $385.36 | $191.74 |
| Metropolitan Philadelphia, PAPennsylvania | $407.48 | $205.11 |
| Rest of PennsylvaniaPennsylvania | $369.16 | $190.71 |
| Puerto RicoPuerto Rico | $394.07 | $197.54 |
| Rhode IslandRhode Island | $400.38 | $199.57 |
| South CarolinaSouth Carolina | $369.10 | $189.48 |
| South DakotaSouth Dakota | $380.15 | $185.75 |
| TennesseeTennessee | $359.86 | $183.16 |
| Austin, TXTexas | $404.85 | $199.19 |
| Beaumont, TXTexas | $366.80 | $189.90 |
| Brazoria, TXTexas | $386.28 | $193.63 |
| Dallas, TXTexas | $389.02 | $195.41 |
| Fort Worth, TXTexas | $386.64 | $194.97 |
| Galveston, TXTexas | $387.62 | $194.58 |
| Houston, TXTexas | $396.95 | $203.92 |
| Rest of TexasTexas | $376.52 | $192.04 |
| UtahUtah | $374.09 | $191.36 |
| VirginiaVirginia | $382.02 | $190.93 |
| Virgin Islands, VIUnited States Virgin Islands | $394.07 | $197.54 |
| VermontVermont | $380.44 | $187.99 |
| Rest of WashingtonWashington | $402.68 | $197.98 |
| King County, WAWashington | $453.18 | $214.66 |
| WisconsinWisconsin | $368.73 | $182.50 |
| WyomingWyoming | $387.03 | $192.64 |
12054 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$346.46
$460.87
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $457.69 | 1 |
| AL | $351.50 | 1 |
| AR | $346.46 | 1 |
| AZ | $380.93 | 1 |
| CA | $410.50–$511.24 | 29 |
| CO | $405.77 | 1 |
| CT | $417.37 | 1 |
| DC | $445.91 | 1 |
| DE | $387.18 | 1 |
| FL | $388.56–$428.19 | 3 |
| GA | $366.59–$399.39 | 2 |
| GU | $419.98 | 1 |
| HI | $419.98 | 1 |
| IA | $359.04 | 1 |
| ID | $361.64 | 1 |
| IL | $378.38–$415.62 | 4 |
| IN | $363.68 | 1 |
| KS | $358.00 | 1 |
| KY | $361.09 | 1 |
| LA | $360.78–$378.40 | 2 |
| MA | $403.63–$444.80 | 2 |
| MD | $394.33–$445.91 | 3 |
| ME | $364.18–$382.83 | 2 |
| MI | $370.99–$394.03 | 2 |
| MN | $387.02 | 1 |
| MO | $355.06–$378.99 | 3 |
| MS | $350.80 | 1 |
| MT | $391.42 | 1 |
| NC | $367.85 | 1 |
| ND | $381.34 | 1 |
| NE | $360.80 | 1 |
| NH | $400.01 | 1 |
| NJ | $421.64–$441.48 | 2 |
| NM | $373.26 | 1 |
| NV | $388.87 | 1 |
| NY | $373.37–$462.59 | 5 |
| OH | $368.93 | 1 |
| OK | $359.78 | 1 |
| OR | $385.36–$417.84 | 2 |
| PA | $369.16–$407.48 | 2 |
| PR | $394.07 | 1 |
| RI | $400.38 | 1 |
| SC | $369.10 | 1 |
| SD | $380.15 | 1 |
| TN | $359.86 | 1 |
| TX | $366.80–$404.85 | 8 |
| UT | $374.09 | 1 |
| VA | $382.02–$445.91 | 2 |
| VI | $394.07 | 1 |
| VT | $380.44 | 1 |
| WA | $402.68–$453.18 | 2 |
| WI | $368.73 | 1 |
| WV | $364.67 | 1 |
| WY | $387.03 | 1 |
How the 12054 rate is calculated
Each of 12054’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 12054
RVUs × geographic indexes × conversion factor
Work3.41
3.41 RVUs× 1.000 GPCI
Practice expense7.80
7.80 RVUs× 1.000 GPCI
Malpractice0.51
0.51 RVUs× 1.000 GPCI
Adjusted RVUs
11.7200
Conversion factor
$33.4009
Medicare rate
$391.46
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact West Virginia inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
1,427
- Code
- 12054
- Physician work
- 3.41
- Practice expense
- 7.80
- Malpractice
- 0.51
GPCI2026.csv
110
- Locality
- West Virginia
- Physician work
- 1.000
- Practice expense
- 0.869
- Malpractice
- 1.431
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.41 | × 1.000 | 3.4100 |
| Practice expense | 7.80 | × 0.869 | 6.7782 |
| Malpractice | 0.51 | × 1.431 | 0.7298 |
| Total RVUs | 10.9180 | ||
| Conversion factor | × 33.4009 | ||
Office rate, West Virginia$364.67
Office: (3.41 × 1 + 7.8 × 0.869 + 0.51 × 1.431) × $33.4009 = $364.67
Facility: (3.41 × 1 + 1.98 × 0.869 + 0.51 × 1.431) × $33.4009 = $195.74
Payment rules and modifiers for 12054
12054 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 12054
Wound repair, face, 7.6–12.5 cm
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 12054
Wound repair, face, 7.6–12.5 cm
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
12054 without 51 · national office
$391.46
Wound repair, face, 7.6–12.5 cm
12054-51 · Second procedure: 50%
$195.73
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
How 12054 has changed in West Virginia
12054 · Office / nonfacility
$364.67
Effective 2026-10-01
The base rate is $23.41 higher than on 2025-10-01, moving from $341.26 to $364.67 (6.9%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2026
RVU26A
$341.26changed to$364.67
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 3.50 changed to 3.41
- Practice expense RVU 7.39 changed to 7.80
- Practice expense GPCI 0.862 changed to 0.869
- Malpractice GPCI 1.333 changed to 1.431
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$354.50changed to$341.26
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 7.49 changed to 7.39
- Malpractice RVU 0.52 changed to 0.51
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$348.71changed to$354.50
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$361.80changed to$348.71
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 7.55 changed to 7.49
- Malpractice RVU 0.54 changed to 0.52
- Practice expense GPCI 0.860 changed to 0.862
- Malpractice GPCI 1.266 changed to 1.333
January 1, 2023
RVU23A
$367.03changed to$361.80
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 7.50 changed to 7.55
- Malpractice RVU 0.56 changed to 0.54
- Practice expense GPCI 0.858 changed to 0.860
- Malpractice GPCI 1.198 changed to 1.266
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$367.74changed to$367.03
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 7.45 changed to 7.50
- Malpractice RVU 0.54 changed to 0.56
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$357.22changed to$367.74
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 6.68 changed to 7.45
- Practice expense GPCI 0.857 changed to 0.858
- Malpractice GPCI 1.247 changed to 1.198
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$349.33changed to$357.22
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 6.44 changed to 6.68
- Malpractice RVU 0.52 changed to 0.54
- Malpractice GPCI 1.296 changed to 1.247
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$343.08changed to$349.33
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 6.25 changed to 6.44
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$338.29changed to$343.08
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 6.19 changed to 6.25
- Malpractice RVU 0.53 changed to 0.52
- Practice expense GPCI 0.847 changed to 0.857
- Malpractice GPCI 1.289 changed to 1.296
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$334.62changed to$338.29
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 6.18 changed to 6.19
- Practice expense GPCI 0.836 changed to 0.847
- Malpractice GPCI 1.282 changed to 1.289
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$340.78changed to$334.62
- Conversion factor 35.9335 changed to 35.8043
- Practice expense RVU 6.36 changed to 6.18
- Malpractice RVU 0.52 changed to 0.53
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$339.08changed to$340.78
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$336.56changed to$339.08
- Conversion factor 35.8228 changed to 35.7547
- Practice expense RVU 6.24 changed to 6.36
- Malpractice RVU 0.56 changed to 0.52
- Practice expense GPCI 0.832 changed to 0.836
- Malpractice GPCI 1.256 changed to 1.282
Held through RVU15B.
January 1, 2014
RVU14A
$342.08changed to$336.56
- Conversion factor 34.0230 changed to 35.8228
- Practice expense RVU 7.04 changed to 6.24
- Malpractice RVU 0.59 changed to 0.56
- Practice expense GPCI 0.828 changed to 0.832
- Malpractice GPCI 1.229 changed to 1.256
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $342.08
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $364.67 | $195.74 | RVU26D |
| 2026-07-01 | $364.67 | $195.74 | RVU26C |
| 2026-04-01 | $364.67 | $195.74 | RVU26B |
| 2026-01-01 | $364.67 | $195.74 | RVU26A |
| 2025-10-01 | $341.26 | $208.26 | RVU25D |
| 2025-07-01 | $341.26 | $208.26 | RVU25C |
| 2025-04-01 | $341.26 | $208.26 | RVU25B |
| 2025-01-01 | $341.26 | $208.26 | RVU25A |
| 2024-10-01 | $354.50 | $213.32 | RVU24D |
| 2024-07-01 | $354.50 | $213.32 | RVU24C |
| 2024-04-01 | $354.50 | $213.32 | RVU24B |
| 2024-03-09 | $354.50 | $213.32 | RVU24AR |
| 2024-01-01 | $348.71 | $209.84 | RVU24A |
| 2023-10-01 | $361.80 | $214.63 | RVU23D |
| 2023-07-01 | $361.80 | $214.63 | RVU23C |
| 2023-04-01 | $361.80 | $214.63 | RVU23B |
| 2023-01-01 | $361.80 | $214.63 | RVU23A |
| 2022-10-01 | $367.03 | $214.11 | RVU22D |
| 2022-07-01 | $367.03 | $214.11 | RVU22C |
| 2022-04-01 | $367.03 | $214.11 | RVU22B |
| 2022-01-01 | $367.03 | $214.11 | RVU22A |
| 2021-10-01 | $367.74 | $214.16 | RVU21D |
| 2021-07-01 | $367.74 | $214.16 | RVU21C |
| 2021-04-01 | $367.74 | $214.16 | RVU21B |
| 2021-01-01 | $367.74 | $214.16 | RVU21A |
| 2020-10-01 | $357.22 | $222.06 | RVU20D |
| 2020-07-01 | $357.22 | $222.06 | RVU20C |
| 2020-04-01 | $357.22 | $222.06 | RVU20B |
| 2020-01-01 | $357.22 | $222.06 | RVU20A |
| 2019-10-01 | $349.33 | $223.01 | RVU19D |
| 2019-07-01 | $349.33 | $223.01 | RVU19C |
| 2019-04-01 | $349.33 | $223.01 | RVU19B |
| 2019-01-01 | $349.33 | $223.01 | RVU19A |
| 2018-10-01 | $343.08 | $223.99 | RVU18D |
| 2018-07-01 | $343.08 | $223.99 | RVU18C |
| 2018-04-01 | $343.08 | $223.99 | RVU18B |
| 2018-01-01 | $343.08 | $223.99 | RVU18AR1 |
| 2017-10-01 | $338.29 | $222.48 | RVU17D |
| 2017-07-01 | $338.29 | $222.48 | RVU17C |
| 2017-04-01 | $338.29 | $222.48 | RVU17B |
| 2017-01-01 | $338.29 | $222.48 | RVU17A |
| 2016-10-01 | $334.62 | $220.58 | RVU16D |
| 2016-07-01 | $334.62 | $220.58 | RVU16C |
| 2016-04-01 | $334.62 | $220.58 | RVU16B |
| 2016-01-01 | $334.62 | $220.58 | RVU16A |
| 2015-10-01 | $340.78 | $225.12 | RVU15D |
| 2015-07-01 | $340.78 | $225.12 | RVU15C |
| 2015-04-01 | $339.08 | $224.00 | RVU15B |
| 2015-01-01 | $339.08 | $224.00 | RVU15A |
| 2014-10-01 | $336.56 | $224.19 | RVU14D |
| 2014-07-01 | $336.56 | $224.19 | RVU14C |
| 2014-04-01 | $336.56 | $224.19 | RVU14B |
| 2014-01-01 | $336.56 | $224.19 | RVU14A |
| 2013-10-01 | $342.08 | $220.94 | RVU13D |
| 2013-07-01 | $342.08 | $220.94 | RVU13C |
| 2013-04-01 | $342.08 | $220.94 | RVU13B |
| 2013-01-01 | $342.08 | $220.94 | RVU13AR |
Where the West Virginia rate applies
West Virginia is a Medicare payment area, not a city. Our Census mapping connects it to 439 cities and communities in West Virginia. Some span more than one payment area; confirm with the service ZIP.
- Accoville
- Addison (Webster Springs)
- Adrian
- Albright
- Alderson
- Alum Creek
- Amherstdale
- Anawalt
12054 billing questions
How is the length selected when there are multiple facial wounds?
Add the lengths of wounds that share the same repair classification and anatomic grouping. Use the resulting total to select the applicable length range.
What documentation supports intermediate rather than simple repair?
Document the wound sites and lengths, the tissue layers closed, and the closure technique. For single-layer closure, record the heavy contamination and extensive cleaning that support intermediate classification.
Can the repair layers be billed separately?
No. The layered closure is part of the repair service; do not report a separate charge for each layer.
Is modifier 50 appropriate for repairs on both sides of the face?
No. Bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.
Are related postoperative visits separately payable during the global period?
Related postoperative visits during the 10-day global period are included in the procedure.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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