$340.27–$375.47
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.
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CMS RVU26D · Effective 2026-10-01
12054 Wound repair Medicare reimbursement rates in Pennsylvania
Report this code for intermediate repair of qualifying facial or mucosal wounds when the combined repaired length falls within the 7.6–12.5 cm range. Compare 12054 office and facility rates across CMS payment localities in Pennsylvania.
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 12054 in Pennsylvania?
Pennsylvania has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$369.16–$407.48
2 of 2 localities have a supported rate.
Facility setting
$190.71–$205.11
2 of 2 localities have a supported rate.
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 12054: Intermediate facial wound repair
Report this code for intermediate repair of qualifying facial or mucosal wounds when the combined repaired length falls within the 7.6–12.5 cm range.
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.
CMS billing rules for 12054
- 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 RVU3.41 · 29%
- Practice expense (office) RVU7.80 · 67%
- Malpractice RVU0.51 · 4%
3.9K
Medicare services in 2024 · #2021 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.
12054 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
$513.83–$569.24
Use 12055 when the total qualifying intermediate facial repair length is 12.6–20 cm; this code covers 7.6–12.5 cm.
$199.16–$220.15
12015 is for simple facial repair in this length range. Choose this code when the repair meets intermediate criteria, such as layered closure.
$315.53–$348.15
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.
Compare 12054 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.
2 of 2 payment localities
Metropolitan Philadelphia →
Office / nonfacility
$407.48
Facility
$205.11
Rest Of Pennsylvania →
Office / nonfacility
$369.16
Facility
$190.71
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12054 billing questions
How is the length selected when there are multiple facial wounds?
Add the lengths of wounds that share the same repair classification and anatomic grouping. Use the resulting total to select the applicable length range.
What documentation supports intermediate rather than simple repair?
Document the wound sites and lengths, the tissue layers closed, and the closure technique. For single-layer closure, record the heavy contamination and extensive cleaning that support intermediate classification.
Can the repair layers be billed separately?
No. The layered closure is part of the repair service; do not report a separate charge for each layer.
Is modifier 50 appropriate for repairs on both sides of the face?
No. Bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.
Are related postoperative visits separately payable during the global period?
Related postoperative visits during the 10-day global period are included in the procedure.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery 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.
1,42412051,,Intmd rpr face/mm 2.5 cm/<,A,,2.27,5.91,,1.91,,0.29,8.47,4.47,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,42512052,,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