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See a sample rate comparisonCPT 12055 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Intmd Rpr Face Mm 12 6 20 Cm, Repair Intermediate Wounds Of Face Ears Eyelids Nose Lips And Or Mucous Membranes 12 6 Cm To 20 0 Cm
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Integumentary System |
| Common Place of Service | 23 - Emergency Room 21 - Inpatient Hospital |
| Common Modifiers | None 59 - Distinct Procedural Service GC - Service performed by resident under supervision |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 12055 |
| Medicaid Fee Schedule | View Medicaid rates for 12055 |
National average reimbursement for CPT 12055 by major payers:
$526.29
$588.34
$613.64
$781.94
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CPT 12055
5 of 25 sample ratesHigher to lower in this preview
Surgical Center At Millburn, LLC
Surgical Center At Millburn LLC
$1,857.00Published rateSpringfield Clinic LLP, Springfield Clinic Ambulatory Surgery Center
Springfield Clinic, LLP
$578.00Published rateSouthwestern Eye Center Ltd, Southwestern Eye Center
Southwestern Eye Center, Ltd.
$344.00Published rateThe Waldorf Endoscopy Asc, LLC, Waldorf Endoscopy Center
The Waldorf Endoscopy Asc LLC
$109.00Published rateJ J Young Md, The Cataract Center Of Lawton
J J Young Md
$56.00Published rate
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See a sample payer proposalCPT 12055 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 12055 code is part of the Surgery services used for Surgical Procedures on the Integumentary System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 12055 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 12054-CPT | Moderate | Intmd Rpr Face Mm 7 6 12 5cm, Repair Intermediate Wounds Of Face Ears Eyelids Nose Lips And Or Mucous Membranes 7 6 Cm To 12 5 Cm |
| 12055-CPT | Moderate | Intmd Rpr Face Mm 12 6 20 Cm, Repair Intermediate Wounds Of Face Ears Eyelids Nose Lips And Or Mucous Membranes 12 6 Cm To 20 0 Cm |
| 12056-CPT | Moderate | Intmd Rpr Face Mm 20 1 30 0, Repair Intermediate Wounds Of Face Ears Eyelids Nose Lips And Or Mucous Membranes 20 1 Cm To 30 0 Cm |
| 12057-CPT | Moderate | Intmd Rpr Face Mm 30 0 Cm, Repair Intermediate Wounds Of Face Ears Eyelids Nose Lips And Or Mucous Membranes Over 30 0 Cm |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 12055. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 12055 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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