No office rate
Choose 20100 for a penetrating wound in the neck; this code is for an extremity wound.
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CMS RVU26D · Effective 2026-10-01
20103 Wound exploration Medicare reimbursement rates in Delaware
Surgical exploration of a penetrating wound in an arm or leg to assess its depth and injured structures, reported when exploration is distinct. Compare 20103 office and facility rates across CMS payment localities in Delaware.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 20103 in Delaware?
Delaware has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$584.99
1 of 1 localities have a supported rate.
Payment area: Delaware
One mapped payment locality.
Facility setting
$312.74
1 of 1 localities have a supported rate.
Payment area: Delaware
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Trauma surgery
About 20103: Penetrating extremity wound exploration
Surgical exploration of a penetrating wound in an arm or leg to assess its depth and injured structures, reported when exploration is distinct.
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.
CMS billing rules for 20103
- Global period
- Minor procedure with a 10-day global period: related postoperative visits for 10 days are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU5.21 · 29%
- Practice expense (office) RVU11.49 · 65%
- Malpractice RVU1.03 · 6%
1.4K
Medicare services in 2024 · #2713 by national volume
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.
20103 compared with similar codes
Office rates for Delaware, from the same CMS release.
Compare 20103 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Delaware →
Office / nonfacility
$584.99
Facility
$312.74
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 20103 in Delaware.
PPRRVU2026_Oct_nonQPP.csv
1,719
- Code
- 20103
- Physician work
- 5.21
- Practice expense
- 11.49
- Malpractice
- 1.03
GPCI2026.csv
40
- Locality
- Delaware
- Physician work
- 1.005
- Practice expense
- 0.988
- Malpractice
- 0.899
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 5.21 | × 1.005 | 5.2360 |
| Practice expense | 11.49 | × 0.988 | 11.3521 |
| Malpractice | 1.03 | × 0.899 | 0.9260 |
| Total RVUs | 17.5141 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Delaware$584.99
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 5.21 | 1.005 |
| Practice expense | 11.49 | 0.988 |
| Malpractice | 1.03 | 0.899 |
(5.21 × 1.005 + 11.49 × 0.988 + 1.03 × 0.899) × $33.4009 = $584.99
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 5.21 | 1.005 |
| Practice expense | 3.24 | 0.988 |
| Malpractice | 1.03 | 0.899 |
(5.21 × 1.005 + 3.24 × 0.988 + 1.03 × 0.899) × $33.4009 = $312.74
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
20103 billing questions
When should this code be selected instead of a wound code for another body region?
Use it for operative exploration of a penetrating wound in an arm or leg. Codes 20100 through 20102 designate wounds in the neck, chest, or abdomen/flank/back, respectively.
Can exploration be billed separately from repair of the same wound?
Usually not when the exploration is integral to a more extensive repair of that injury during the same session. Report it when the exploration is a distinct service rather than a routine step in definitive treatment.
Does this code include related postoperative visits?
Yes. Medicare includes related postoperative visits for 10 days in the global period.
Should modifier 50 be used for wounds on both limbs?
No. The CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.
What documentation supports assistant-at-surgery payment?
The record must support the medical necessity of the assistant's participation. Medicare does not permit co-surgeon or team-surgery payment for this code.
How are multiple procedures in the same session paid?
The highest-valued procedure is paid in full; other procedures are subject to the standard multiple-procedure reduction, with payment at 50%.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
1,71620100,,Expl pentrg wound neck,A,,10.12,4.00,NA,4.00,,2.22,16.34,16.34,0,010,0.10,0.80,0.10,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,71720101,,Expl pentrg wound chest,A,,3.15,14.76,,2.05,,0.84,18.75,6.04,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,71820102,,Expl pentrg wnd abd/flnk/bk,A,,3.88,14.95,,2.47,,0.99,19.82,7.34,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,71920103,,Expl pentrg wound extremity,A,,5.21,11.49,,3.24,,1.03,17.73,9.48,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,7202010F,,Vital signs recorded,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
1,7212014F,,Mental status assess,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
1,72220150,,Excision epiphyseal bar,A,,14.38,10.14,NA,10.14,,3.05,27.57,27.57,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808
4209102,FL,04,MIAMI,1.000,1.041,2.529
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503