Billing code 12054: Wound repairMedicare rate & RVUs

Medicare pays $391.46 for 12054 nationally in the office and $197.07 in a hospital or facility. Local office rates run $346.46–$511.24.

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

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.

Where 12054 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

12054 rates by state

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

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.

Payment rules and modifiers for 12054

12054 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

12054 compared with similar codes

How to choose

12053Wound repair

Use 12053 when the total qualifying intermediate facial repair length is 5.1–7.5 cm; use this code for 7.6–12.5 cm.

12055Wound repair

Use 12055 when the total qualifying intermediate facial repair length is 12.6–20 cm; this code covers 7.6–12.5 cm.

12015Simple wound repair

12015 is for simple facial repair in this length range. Choose this code when the repair meets intermediate criteria, such as layered closure.

12034Wound repair

Both codes cover intermediate repair in the 7.6–12.5 cm range, but 12034 is for a different anatomic grouping, including scalp, trunk, or extremities.

Codes related to 12054

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

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