Summary & Overview

CPT 12054: Intermediate Repair of Facial and Mucous Membrane Wound (7.6–12.5 cm)

CPT code 12054 denotes an intermediate repair of wounds to the face, ears, eyelids, nose, lips, and mucous membranes measuring 7.6 to 12.5 cm. This code captures a common category of minor surgical procedures focused on layered closure for cosmetically and functionally sensitive facial areas. Accurate coding for these repairs is important nationally because it affects clinical documentation, procedure classification, and reimbursement for outpatient surgical services performed by dermatology, plastic surgery, otolaryngology, and general surgery providers.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the procedure captured by the code, typical sites of service, and the clinical context for when this code applies. The publication also summarizes common modifier usage and payer coverage considerations where available, benchmarks for utilization patterns, and recent policy updates that affect coding and billing for intermediate facial wound repairs.

This resource is intended for clinicians, coding professionals, and revenue cycle staff seeking a clear, national-level reference on when to use CPT code 12054, how it fits within wound-repair code ranges, and what payer contract and policy factors commonly influence billing and reimbursement outcomes.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare12054CPTwound repairfacial lacerationoutpatient surgerydermatologic surgeryplastic surgeryprocedure coding

Billing Code Overview

CPT code 12054 describes an intermediate repair of wounds to the face, ears, eyelids, nose, lips, and/or mucous membranes measuring 7.6 to 12.5 cm. This procedure typically involves layered closure and may include closure of deeper structures beneath the skin to achieve anatomic and functional restoration.

Service type: Intermediate wound repair
Typical site of service: Ambulatory surgical centers, hospital outpatient departments, and physician offices where minor surgical procedures on the face and mucous membranes are performed.

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 34-year-old male presents to the emergency department after sustaining a laceration to his left cheek from a fall on concrete. The wound measures approximately 9 cm in length and involves subcutaneous tissue without exposed bone or major salivary duct involvement. After local infiltration with lidocaine with epinephrine, the emergency physician performs irrigation and debridement followed by layered closure (deep dermal sutures and epidermal approximation) using interrupted absorbable sutures for the deeper layer and nonabsorbable skin sutures for the skin. Hemostasis is obtained, and the patient is discharged with wound care instructions and a follow-up visit scheduled for suture removal.

Typical workflow steps:

Triage and wound assessment, including size measurement and neurovascular/perforator evaluation.
Local anesthesia administration and procedural consent.
Wound irrigation, removal of gross contamination, and debridement of nonviable tissue.
Layered (intermediate) closure of subcutaneous tissue and skin approximations for a 7.6–12.5 cm facial wound using deep and superficial sutures.
Documentation of wound length, location (face, ear, eyelid, nose, lip, mucous membrane), complexity, anesthesia, and any complicating factors.
Postprocedure instructions and scheduling of follow-up for suture removal and wound check.

Coding Specifications

Modifier

Taxonomy Code	Specialty	Notes
`207Q00000X`	Otolaryngology (ENT)	Facial and nasal soft tissue repairs commonly performed by ENT for complex facial wounds.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S01.411A`	Laceration without foreign body of left cheek and temporal region, initial encounter	Facial lacerations of the cheek commonly require intermediate layered closure when wound length is 7.6–12.5 cm.

S01.401A | Laceration without foreign body of unspecified cheek and temporal region, initial encounter | General facial laceration code applicable when site specificity is not recorded but intermediate repair is performed.

S01.501A | Laceration without foreign body of lip, initial encounter | Lip lacerations involving mucosa often require layered closure techniques consistent with 12054 when length criteria met.

S01.81XA | Laceration without foreign body of other parts of head, initial encounter | Used for head/face lacerations not otherwise specified requiring intermediate repair.

S01.402A | Laceration without foreign body of right cheek and temporal region, initial encounter | Right-sided counterpart for cheek lacerations meeting size criteria for 12054.

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