$417.37
Use 12054 for the same intermediate repair class and anatomic grouping when the combined repaired length is 7.6–12.5 cm.
On this page
CMS RVU26D · Effective 2026-10-01
12055 Wound repair Medicare reimbursement rates in Connecticut
Reports intermediate repair of qualifying facial and mucosal wounds when the combined repaired length is 12.6–20 cm. Compare 12055 office and facility rates across CMS payment localities in Connecticut.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 12055 in Connecticut?
Connecticut has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$583.35
1 of 1 localities have a supported rate.
Payment area: Connecticut
One mapped payment locality.
Facility setting
$312.47
1 of 1 localities have a supported rate.
Payment area: Connecticut
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Wound repair
About 12055: Intermediate facial wound repair, 12.6–20 cm
Reports intermediate repair of qualifying facial and mucosal wounds when the combined repaired length is 12.6–20 cm.
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.
CMS billing rules for 12055
- Global period
- Minor procedure with a 10-day global period: related postoperative visits for 10 days are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU4.39 · 27%
- Practice expense (office) RVU11.07 · 68%
- Malpractice RVU0.88 · 5%
303
Medicare services in 2024 · #3987 by national volume
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.
12055 compared with similar codes
Office rates for Connecticut, from the same CMS release.
$666.03
Use 12056 when the same intermediate repair class and anatomic grouping has a combined repaired length of 20.1–30 cm.
$285.88
This code is for simple facial repair in the 12.6–20 cm range; 12055 requires intermediate repair work.
$442.32
This code covers intermediate repair in the same length range for a different anatomic grouping, not the face and mucous-membrane grouping.
Compare 12055 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Connecticut →
Office / nonfacility
$583.35
Facility
$312.47
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 12055 in Connecticut.
PPRRVU2026_Oct_nonQPP.csv
1,428
- Code
- 12055
- Physician work
- 4.39
- Practice expense
- 11.07
- Malpractice
- 0.88
GPCI2026.csv
38
- Locality
- Connecticut
- Physician work
- 1.020
- Practice expense
- 1.077
- Malpractice
- 1.210
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 4.39 | × 1.020 | 4.4778 |
| Practice expense | 11.07 | × 1.077 | 11.9224 |
| Malpractice | 0.88 | × 1.210 | 1.0648 |
| Total RVUs | 17.4650 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Connecticut$583.35
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.39 | 1.02 |
| Practice expense | 11.07 | 1.077 |
| Malpractice | 0.88 | 1.21 |
(4.39 × 1.02 + 11.07 × 1.077 + 0.88 × 1.21) × $33.4009 = $583.35
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.39 | 1.02 |
| Practice expense | 3.54 | 1.077 |
| Malpractice | 0.88 | 1.21 |
(4.39 × 1.02 + 3.54 × 1.077 + 0.88 × 1.21) × $33.4009 = $312.47
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
1,42512052,,Intmd rpr face/mm 2.6-5.0 cm,A,,2.80,6.20,,2.03,,0.34,9.34,5.17,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,42612053,,Intmd rpr face/mm 5.1-7.5 cm,A,,3.09,7.33,,2.12,,0.39,10.81,5.60,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,42712054,,Intmd rpr face/mm 7.6-12.5cm,A,,3.41,7.80,,1.98,,0.51,11.72,5.90,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,42812055,,Intmd rpr face/mm 12.6-20 cm,A,,4.39,11.07,,3.54,,0.88,16.34,8.81,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,42912056,,Intmd rpr face/mm 20.1-30.0,A,,5.17,12.54,,4.31,,0.96,18.67,10.44,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,43012057,,Intmd rpr face/mm >30.0 cm,A,,5.85,12.48,,4.51,,1.09,19.42,11.45,0,010,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,4311205F,,Epi etiol synd rvwd and docd,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
3501112,CA,70,YUBA CITY,1.017,1.096,0.536
3601112,CA,75,REST OF CALIFORNIA,1.017,1.096,0.536
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808