Intmd rpr face/mm 12.6-20 cm

CPT 12055 covers intermediate repair of wounds on the face, ears, eyelids, nose, lips, or mucous membranes measuring 12.6 to 20.0 centimeters in total length. This includes layered closure of wounds that require more than simple stitching but less than complex reconstruction.

Showing rates for

National Average

Base Medicare rate

$485.52

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

4.5

PE RVU (NF)

9.69

MP RVU

0.82

Total RVU

15.01

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Measure and document total wound length accurately before repair; combine all wounds in same anatomic grouping (face/ears/eyelids/nose/lips/mucous membranes) to reach the 12.6-20 cm range
Impact: Ensures correct code selection; undercoding to 12054 (7.6-12.5 cm) costs $127.34 in lost revenue per case
Document layered closure explicitly in operative note, specifying subcutaneous layer closure (material, technique) separate from skin closure
Impact: Prevents downcoding to simple repair codes (12011-12018) which pay $142.72-$246.66 versus $485.52 for proper intermediate repair documentation
Bill facility versus non-facility setting correctly; physician office/clinic uses non-facility rate ($485.52) while hospital ED or ASC uses facility rate ($294.03)
Impact: Prevents claim rejection and ensures correct reimbursement; $191.49 difference between settings affects revenue reconciliation
Do not separately bill for simple debridement or local anesthesia—these are included in the repair code and will be denied as bundled
Impact: Avoids automatic denials and reduces audit risk; attempting to bill 11042 or 64400 series with 12055 triggers NCCI edits
When multiple wounds total more than 20 cm, use CPT 13132-13133 (complex repair) if layered closure performed, as intermediate repair codes cap at 20 cm
Impact: Complex repair codes pay significantly more; 13132 pays $714.29, yielding $228.77 additional revenue for properly documented cases exceeding 20 cm
Photograph wounds before and after repair with measurement marker visible in pre-repair image; retain images for minimum 7 years

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 12055 in 2025?

Medicare pays $485.52 for CPT 12055 in non-facility settings (physician office) and $294.03 in facility settings (hospital, ASC) based on the 2025 Medicare Physician Fee Schedule with national average rates.

How many RVUs is CPT code 12055 worth?

CPT 12055 has 15.01 total RVUs in 2025, composed of 4.5 work RVUs, 9.69 non-facility practice expense RVUs (3.77 facility PE RVUs), and 0.82 malpractice RVUs.

Can I bill CPT 12055 with an E/M code on the same day?

Yes, but you must append modifier 25 to the E/M code and document a significant, separately identifiable evaluation and management service beyond the wound assessment and repair decision. The E/M must address additional patient concerns or medical issues distinct from the laceration repair itself.

What is the difference between CPT 12055 and 12054?

CPT 12054 covers intermediate facial repair of 7.6-12.5 cm total wound length (pays $358.18), while 12055 covers 12.6-20.0 cm (pays $485.52). The codes differ only in total combined wound measurement; both require the same layered closure technique and anatomic locations.

Do I need to add up multiple facial wounds for CPT 12055?

Yes, when multiple wounds in the same anatomic grouping (face, ears, eyelids, nose, lips, mucous membranes) are repaired with intermediate technique, you sum the lengths of all wounds and report a single code. For example, three facial wounds of 5 cm, 4 cm, and 6 cm total 15 cm, qualifying for 12055.

What documentation is required to bill CPT 12055 without audit risk?

Document exact wound measurements totaling 12.6-20 cm, specific facial anatomic locations, layered closure technique with separate documentation of subcutaneous and skin layer closure including suture materials, wound preparation details, and clinical photographs with measurement markers when possible. Operative notes must clearly support intermediate (not simple) repair complexity.

When should I use CPT 12055 versus a complex repair code?

Use 12055 for layered closure of facial wounds 12.6-20 cm requiring subcutaneous and skin closure. Use complex repair codes (13131-13133) when repair involves extensive undermining, stents, retention sutures, or wounds exceeding 20 cm total length. Complex repairs require additional reconstructive techniques beyond layered closure and reimburse at higher rates.