Billing code 12056: Wound repairMedicare rate & RVUs

Medicare pays $623.59 for 12056 nationally in the office and $348.71 in a hospital or facility. Local office rates run $548.99–$812.84.

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

What 12056 covers

This service closes a wound in layers when repair involves more than a single-layer skin closure, typically bringing deeper tissue together before closing the skin. Common situations include traumatic lacerations of the cheek, lip, eyelid, ear, or nose, as well as wounds involving mucous membrane sites in this anatomic group. Emergency physicians, plastic surgeons, dermatologic surgeons, and other clinicians who perform wound repair may report it in emergency, office, or facility settings.

Select the code based on intermediate repair complexity, the anatomic group, and a total repaired length of 20.1–30 cm. For multiple qualifying wounds in the same group, combine their repaired lengths. Document each wound’s location and length, the layered technique, and any extensive cleaning that supports intermediate-level work. CMS assigns a 10-day global period, which includes related postoperative visits during that period. For multiple procedures in one session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate for this code. Assistant-at-surgery payment requires documented medical necessity; 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 12056 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

12056 rates by state

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

How the 12056 rate is calculated

Each of 12056’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 12056

12056 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

12056 compared with similar codes

How to choose

12055Wound repair

Use 12055 for the shorter adjacent facial intermediate-repair length range; 12056 is for a total of 20.1–30 cm.

12057Wound repair

Use 12057 when the total facial intermediate-repair length exceeds 30 cm. A total of 20.1–30 cm falls under 12056.

12036Wound repair

Both codes cover intermediate repair in the 20.1–30 cm range, but 12036 is for its own anatomic group rather than the face, ears, eyelids, nose, lips, or mucous membranes.

12017Wound repair

This is a complex repair code for the facial anatomic group and length range. Choose based on whether the documented repair meets complex rather than intermediate repair criteria.

Codes related to 12056

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