Billing code 20101: Wound explorationMedicare rate & RVUs

Medicare pays $626.27 for 20101 nationally in the office and $201.74 in a hospital or facility. Local office rates run $543.15–$842.73.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 20101 covers

A surgeon explores a penetrating wound of the chest to assess the wound tract and determine whether underlying structures are involved. This service may occur in a hospital operating room after a stab, gunshot, or other penetrating injury. The operative note should make clear that surgical exploration was performed and identify the chest wound and the extent of the exploration; a brief inspection during routine wound care is not the same service. This code is specific to the chest region, not the neck, abdomen, back, flank, or extremity.

Select the code by the wound’s anatomic region, not by the mechanism or apparent severity of injury. Document the operative findings and work performed so the record supports exploration rather than simple examination or wound care. Medicare assigns a 10-day global period, so related postoperative visits during that period are included. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple procedure reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this code; co-surgeons and team surgery are not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 20101 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

20101 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 20101 rate is calculated

Each of 20101’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 20101

20101 has a 10-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 51

20101 compared with similar codes

How to choose

20100Wound exploration

Use 20100 when the penetrating wound explored is in the neck; 20101 is for the chest.

20102Wound exploration

Use 20102 for an explored wound of the abdomen, flank, or back. A chest wound is reported with 20101.

20103Wound exploration

Use 20103 when the explored penetrating wound is in an extremity, rather than the chest.

Codes related to 20101

Related codes aren’t interchangeable: bill the code that matches the service performed.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates