Billing code 12056: Wound repairMedicare rate & RVUs in Guam
Reports layered intermediate repair of a wound in the facial, ear, eyelid, nose, lip, or mucous membrane group when total repaired length is 20.1–30 cm.
Medicare pays $667.48 for 12056 in the office in Guam (Hawaii, Guam). Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
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.
12056 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | $667.48 | $354.93 |
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.
How the rate is built · 12056
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 5.17Practice expense 12.54Malpractice 0.96
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 12056
12056 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 12056
Wound repair
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 12056
Wound repair
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
12056 without 51 · national office
$623.59
Wound repair
12056-51 · Second procedure: 50%
$311.80
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
12056 compared with similar codes
Compare codes
12056 vs 12055 vs 12057 vs 12036 vs 12017: national Medicare rates
Swap in your local Medicare rate.
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.
12056 billing questions
How is 12056 distinguished from 12055 or 12057?
Choose by total repaired length in the facial anatomic group: 12056 covers 20.1–30 cm. Code 12055 covers the shorter adjacent range, while 12057 is for lengths over 30 cm.
What documentation supports intermediate repair?
Record the wound site and repaired length, along with the layered closure technique. Describe extensive cleaning when it is part of the work supporting intermediate-level repair.
Can the lengths of multiple wounds be combined?
Combine lengths for qualifying wounds in the same anatomic and repair category when selecting the length range. Keep the location and repaired length of each wound in the record.
Should modifier 50 be appended for wounds on both sides of the face?
No. CMS identifies bilateral adjustment as inappropriate for this code; report based on the qualifying repair length and circumstances.
How are multiple procedures and postoperative visits handled?
CMS includes related postoperative visits for 10 days in the global period. In a same-session multiple-procedure situation, the highest-valued procedure is paid in full and others at 50%.
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
Show the CMS file lines behind this rate
Fee sheets
Put 12056 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →