Billing code 20103: Wound explorationMedicare rate & RVUs

Medicare pays $592.20 for 20103 nationally in the office and $316.64 in a hospital or facility. Local office rates run $521.40–$765.01.

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

What 20103 covers

A surgeon explores a penetrating injury in an arm or leg, such as a stab or gunshot wound, to assess the wound track and identify damage to underlying structures or retained material. The service may be performed by a trauma, orthopedic, hand, or vascular surgeon in an operating room or other appropriate procedure setting. It is more than inspecting or gently probing a wound during an initial examination.

Report the code when operative exploration is a distinct service; exploration that is integral to a more extensive repair of the same injury is generally not separately reported. The operative note should identify the extremity, wound location, reason for exploration, and findings or structures assessed. Medicare assigns a 10-day global period, including related postoperative visits during that period. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment requires medical-necessity documentation; 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 20103 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

20103 rates by state

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

How the 20103 rate is calculated

Each of 20103’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 20103

20103 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

20103 compared with similar codes

How to choose

20100Wound exploration

Choose 20100 for a penetrating wound in the neck; this code is for an extremity wound.

20101Wound exploration

Choose 20101 for a penetrating wound in the chest. This code applies to an arm or leg.

20102Wound exploration

Choose 20102 for a penetrating wound of the abdomen, flank, or back; this code applies to an extremity.

Codes related to 20103

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