Intmd rpr face/mm >30.0 cm

CPT code 12057 covers intermediate-complexity repair of facial wounds or wounds on mucous membranes when the total length of all wounds being repaired exceeds 30.0 centimeters. This is used for layered closures requiring suturing of deeper tissue layers in addition to skin.

Showing rates for

National Average

Base Medicare rate

$586.44

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

PE RVU (NF)

11.02

MP RVU

1.11

Total RVU

18.13

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 precisely before repair begins. Add together all wounds repaired with intermediate technique in the face/mucous membrane region, as 12057 is based on cumulative length >30 cm.
Impact: Proper measurement prevents downcoding to 12056 (20.1-30.0 cm, pays $450.77) saving $135.67 per case or upcoding concerns that trigger audits.
Document layered closure technique explicitly, noting closure of subcutaneous tissue layer(s) separately from skin closure. Include suture types and sizes for each layer.
Impact: Insufficient layer documentation is the primary cause of downcoding to simple repair codes (12011-12018, paying $114.70-$279.56), representing potential loss of $306.88-$471.74.
Bill facility vs non-facility location accurately. The $175.64 difference ($586.44 non-facility vs $410.80 facility) depends on practice setting ownership and equipment costs.
Impact: Billing non-facility rates when procedure performed in facility setting triggers automatic recoupment of $175.64 overpayment plus potential fraud investigation.
For repairs spanning multiple anatomical groupings, bill each anatomical category separately using appropriate codes. Do not combine face/mucous membrane repairs with trunk or extremity repairs under one code.
Impact: Proper code selection by anatomical location optimizes reimbursement. Mixing categories can result in bundling or incorrect application of payment hierarchy.
When wound debridement is performed and documented separately beyond typical wound preparation, consider billing 11042-11047 in addition to repair code with modifier 59 if extensive and well-documented.
Impact: Can add $70-$350 to claim when debridement is extensive and meets separate procedure criteria, but requires clear documentation to avoid bundling denials.

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 12057 in 2025?

The 2025 Medicare national average reimbursement for CPT 12057 is $586.44 for non-facility settings and $410.80 for facility settings. The non-facility rate applies to office-based procedures, while the facility rate applies when performed in hospital outpatient departments or ambulatory surgery centers where facility overhead is billed separately.

How many RVUs is CPT code 12057 worth?

CPT 12057 has a total of 18.13 RVUs in 2025, consisting of 6.0 work RVUs, 11.02 non-facility practice expense RVUs (5.59 facility PE RVUs), and 1.11 malpractice RVUs. The high work RVU reflects the significant physician time and skill required for extensive layered facial repairs.

What is the difference between CPT 12057 and 12056?

The only difference is total wound length: CPT 12056 covers intermediate facial/mucous membrane repairs from 20.1 cm to 30.0 cm, while 12057 covers repairs exceeding 30.0 cm. Both require the same layered closure technique. The reimbursement difference is significant, with 12057 paying $586.44 versus 12056's lower rate, making accurate measurement documentation critical.

Can CPT 12057 be billed with an E/M code on the same day?

Yes, but only when a significant, separately identifiable evaluation and management service is performed and documented beyond the routine assessment included in the decision to perform the repair. Modifier 25 must be appended to the E/M code, and documentation must clearly show the separate nature of the E/M service, such as comprehensive trauma evaluation or assessment of other medical conditions.

How do I measure wound length for CPT 12057 billing?

Measure each individual wound length before beginning repair, then add together all wounds in the face/mucous membrane area being repaired with intermediate technique. The sum must exceed 30.0 cm to qualify for 12057. Measure along the linear wound edge, not across gaps. Document each individual wound measurement and the total sum in your operative note. Do not include wounds repaired with simple technique in this calculation.

What qualifies as intermediate repair for CPT 12057?

Intermediate repair requires layered closure of one or more deeper layers (subcutaneous tissue and/or superficial fascia) in addition to skin closure. This must involve suturing of tissue layers beneath the dermis. Simple single-layer closures, tissue adhesive alone, or Steri-Strips do not qualify. The operative note must document closure of specific tissue layers with suture material to support intermediate repair coding.

Can CPT 12057 be used for scalp repairs?

No, CPT 12057 is specifically for face, ears, eyelids, nose, lips, and mucous membranes only. Scalp repairs use a different code series (12031-12037 for intermediate scalp/neck/axillae/genitalia/trunk/extremities repairs). Using 12057 for scalp repairs will result in claim denial or recoupment as it is anatomically inappropriate.