Billing code 12055: Wound repairMedicare rate & RVUs

Medicare pays $545.77 for 12055 nationally in the office and $294.26 in a hospital or facility. Local office rates run $479.38–$711.69.

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.

Where 12055 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

12055 rates by state

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

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

12055 compared with similar codes

How to choose

12054Wound repair

Use 12054 for the same intermediate repair class and anatomic grouping when the combined repaired length is 7.6–12.5 cm.

12056Wound repair

Use 12056 when the same intermediate repair class and anatomic grouping has a combined repaired length of 20.1–30 cm.

12016Simple wound repair

This code is for simple facial repair in the 12.6–20 cm range; 12055 requires intermediate repair work.

12035Wound repair

This code covers intermediate repair in the same length range for a different anatomic grouping, not the face and mucous-membrane grouping.

Codes related to 12055

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