Billing code 12054: Wound repairMedicare rate & RVUs in Texas
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.
Medicare pays $366.80–$404.85 for 12054 in the office in Texas, from Beaumont to Austin. 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 12054 covers
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.
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 12054 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 payment localities
$366.80 to $404.85
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | $404.85 | $199.19 |
| Beaumont | $366.80 | $189.90 |
| Brazoria | $386.28 | $193.63 |
| Dallas | $389.02 | $195.41 |
| Fort Worth | $386.64 | $194.97 |
| Galveston | $387.62 | $194.58 |
| Houston | $396.95 | $203.92 |
| Rest Of Texas | $376.52 | $192.04 |
How the 12054 rate is calculated
Each of 12054’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 · 12054
RVUs × geographic indexes × conversion factor
Work3.41
3.41 RVUs× 1.000 GPCI
Practice expense7.80
7.80 RVUs× 1.000 GPCI
Malpractice0.51
0.51 RVUs× 1.000 GPCI
Adjusted RVUs
11.7200
Conversion factor
$33.4009
Medicare rate
$391.46
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 12054
12054 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 12054
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) | 1 | Not paid (statutory restriction). |
| 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 · 12054
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
12054 without 51 · national office
$391.46
Wound repair
12054-51 · Second procedure: 50%
$195.73
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%).
12054 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 12053Wound repair
- 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.
- 12055Wound repair
- Use 12055 when the total qualifying intermediate facial repair length is 12.6–20 cm; this code covers 7.6–12.5 cm.
- 12015Simple wound repair
- 12015 is for simple facial repair in this length range. Choose this code when the repair meets intermediate criteria, such as layered closure.
- 12034Wound repair
- 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.
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 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
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