CPT code 12055: Wound repair, face and mucous membranes2026 Medicare rate & RVUs in Missouri
Reports intermediate repair of qualifying facial and mucosal wounds when the combined repaired length is 12.6–20 cm.
Medicare pays $493.98–$528.08 for 12055 in the office in Missouri, from Rest of Missouri to Metropolitan St. Louis, MO. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 12055 covers
Code 12055 represents intermediate closure of one or more wounds in the face, ear, eyelid, nose, lip, or mucous-membrane grouping when the repaired length totals 12.6–20 cm. Intermediate work involves layered closure, typically closing subcutaneous tissue or superficial fascia as well as skin; it can also apply to a heavily contaminated wound closed in one layer after extensive cleaning. Physicians and other qualified practitioners perform these repairs in offices, emergency departments, and hospitals, often after trauma or a procedure leaves a sizable laceration.
Select the code using the completed repaired length, not the wound’s estimated length before repair. Add lengths of repairs within the same anatomic grouping and repair class. Document the site, measured length, tissue layers, and extensive cleaning when contamination supports intermediate classification. CMS assigns a 10-day minor-procedure global period, including related postoperative visits during that period. In a same-session multiple-procedure claim, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate. Assistant-at-surgery services are statutorily unpaid; 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.
Where 12055 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$493.98 to $528.08
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | $522.54 | $286.37 |
| Metropolitan St. Louis, MO | $528.08 | $288.65 |
| Rest of Missouri | $493.98 | $277.18 |
How the 12055 rate is calculated
Each of 12055’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 · 12055
RVUs × geographic indexes × conversion factor
Work4.39
4.39 RVUs× 1.000 GPCI
Practice expense11.07
11.07 RVUs× 1.000 GPCI
Malpractice0.88
0.88 RVUs× 1.000 GPCI
Adjusted RVUs
16.3400
Conversion factor
$33.4009
Medicare rate
$545.77
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 12055
12055 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 12055
Wound repair, face and mucous membranes
| 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 · 12055
Wound repair, face and mucous membranes
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
12055 without 51 · national office
$545.77
Wound repair, face and mucous membranes
12055-51 · Second procedure: 50%
$272.89
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%).
12055 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 12054Wound repairFace, 7.6–12.5 cm
- Use 12054 for the same intermediate repair class and anatomic grouping when the combined repaired length is 7.6–12.5 cm.
- 12056Wound repairFace, 20.1–30 cm
- Use 12056 when the same intermediate repair class and anatomic grouping has a combined repaired length of 20.1–30 cm.
- 12016Simple wound repairFace group, 12.6–20 cm
- This code is for simple facial repair in the 12.6–20 cm range; 12055 requires intermediate repair work.
- 12035Wound repairIntermediate, 12.6–20 cm
- This code covers intermediate repair in the same length range for a different anatomic grouping, not the face and mucous-membrane grouping.
12055 billing questions
When does this repair qualify as intermediate rather than simple?
The repair involves layered closure, such as closing subcutaneous tissue or superficial fascia as well as skin. A heavily contaminated wound may also qualify when extensive cleaning is required, even if closure is in one layer.
How is the length determined when there are multiple facial wounds?
Add the repaired lengths of wounds in the same anatomic grouping and repair class. The combined length must fall within 12.6–20 cm for this code.
Can modifier 50 be used for repairs on both sides of the face?
No. CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.
Are related postoperative visits included?
Yes. The 10-day minor-procedure global period includes related postoperative visits during that period.
How does CMS handle this code when other procedures are performed in the same session?
The highest-valued procedure is paid in full, and other procedures subject to the multiple-procedure reduction are paid at 50%.
Can an assistant surgeon or co-surgeon be reported for this repair?
Assistant-at-surgery services are statutorily unpaid 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
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