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See a sample rate comparisonCPT 12056 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 20 1 30 0, Repair Intermediate Wounds Of Face Ears Eyelids Nose Lips And Or Mucous Membranes 20 1 Cm To 30 0 Cm
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Integumentary System |
| Common Place of Service | 23 - Emergency Room 22 - On Campus Outpatient Hospital 11 - Office |
| Common Modifiers | None 59 - Distinct Procedural Service XU - Unusual Non-Overlapping Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 12056 |
| Medicaid Fee Schedule | View Medicaid rates for 12056 |
National average reimbursement for CPT 12056 by major payers:
$631.32
$694.46
$696.82
$619.63
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CPT 12056
5 of 25 sample ratesHigher to lower in this preview
Indiana University Health Saxony Surgery Center LLC, Saxony Surgery Center
$4,613.00Published ratePremier Eye Surgery Center Of Colorado, LLC, Premier Eye Surgery Center
Premier Eye Surgery Center Of Colorado, LLC
$437.00Published rateWomens Health Center, Hamid Zadeh Md Inc
Womens Health Center
$150.00Published rateKansas Endoscopy LLC
$143.00Published rateVillages Endoscopy Center LLC
$48.00Published rate
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See a sample payer proposalCPT 12056 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 12056 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 12056 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 12056. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 12056 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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