CPT code 12055: Wound repair, face and mucous membranes2026 Medicare rate & RVUs in Puerto Rico

In Puerto Rico, Medicare pays $549.40 for 12055 in the office and $295.12 when it’s performed in a hospital or facility.

Check a contract rate as a % of Medicare · 12055 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

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.

How Puerto Rico compares for 12055

Across 109 of 109 payment localities, the office rate for 12055 runs from $479.38 in Arkansas to $711.69 in San Benito County, CA. Puerto Rico pays $549.40. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

12055 rates by state

Office rate range in each state. Select a state to see its payment localities.

See 12055 in every payment locality

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.

Payment rules and modifiers for 12055

12055 has a 10-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 51

Codes related to 12055

Related codes aren’t interchangeable: bill the code that matches the service performed.

How 12055 has changed in Puerto Rico

Price 12055 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

• Aceitunas
• Adjuntas
• Aguada
• Aguadilla
• Aguas Buenas
• Aguas Claras
• Aguilita
• Aibonito

Browse all communities in Puerto Rico

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

Open CMS sourceHow we calculate rates