$575.86
20101 is for a penetrating wound in the chest; 20100 is for a wound in the neck.
On this page
CMS RVU26D · Effective 2026-10-01
20100 Wound exploration Medicare reimbursement rates in Indiana
Operative exploration of a penetrating neck wound is reported when a surgeon examines the wound and underlying tissues to assess injury. Compare 20100 office and facility rates across CMS payment localities in Indiana.
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 20100 in Indiana?
Indiana 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
No supported rate
Facility setting
$497.90
1 of 1 localities have a supported rate.
Payment area: Indiana
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 20100: Penetrating neck wound exploration
Operative exploration of a penetrating neck wound is reported when a surgeon examines the wound and underlying tissues to assess injury.
CPT 20100 describes operative exploration of a penetrating wound in the neck, such as a stab or gunshot wound. The surgeon examines the wound tract and underlying tissues to assess the extent of injury and identify affected structures. Trauma or general surgeons commonly perform this work in a hospital operating room. Routine inspection, cleaning, or closure of a superficial wound is not the same service as operative exploration.
Select the code based on the wound’s neck location and the documented operative exploration, not simply the mechanism or apparent wound size. The operative report should identify the site, exploration performed, findings, and any injuries or repairs. Related postoperative visits are included in the 10-day global period. When multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Bilateral performance with modifier 50 is paid at 150%. Assistant-at-surgery payment may be made; co-surgeons and team surgery are not permitted.
CMS billing rules for 20100
- 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 procedure with modifier 50 is paid at 150%.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU10.12 · 62%
- Practice expense (office) RVU4.00 · 24%
- Malpractice RVU2.22 · 14%
173
Medicare services in 2024 · #4452 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.
20100 compared with similar codes
Office rates for Indiana, from the same CMS release.
Compare 20100 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
Indiana →
Office / nonfacility
Unavailable
Facility
$497.90
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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 20100 in Indiana.
PPRRVU2026_Oct_nonQPP.csv
1,716
- Code
- 20100
- Physician work
- 10.12
- Practice expense
- 4.00
- Malpractice
- 2.22
GPCI2026.csv
52
- Locality
- Indiana
- Physician work
- 1.000
- Practice expense
- 0.927
- Malpractice
- 0.486
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 10.12 | × 1.000 | 10.1200 |
| Practice expense | 4.00 | × 0.927 | 3.7080 |
| Malpractice | 2.22 | × 0.486 | 1.0789 |
| Total RVUs | 14.9069 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Indiana$497.90
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 10.12 | 1 |
| Practice expense | 4 | 0.927 |
| Malpractice | 2.22 | 0.486 |
(10.12 × 1 + 4 × 0.927 + 2.22 × 0.486) × $33.4009 = $497.90
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.
20100 billing questions
How is 20100 distinguished from the other penetrating-wound exploration codes?
Use 20100 for a penetrating wound in the neck. The related codes distinguish chest, abdomen/flank/back, and extremity locations.
Does a penetrating mechanism alone support 20100?
No. The record should support operative exploration of a penetrating neck wound; the mechanism alone does not establish that the exploration was performed.
Are postoperative visits separately reported during the global period?
Related postoperative visits during the 10-day global period are included in the procedure.
How is 20100 paid when other procedures are performed in the same session?
The highest-valued procedure is paid in full; other procedures performed in that session are subject to the standard 50% multiple-procedure reduction.
Can modifier 50 or an assistant-at-surgery payment apply?
For bilateral performance, modifier 50 is paid at 150%. Assistant-at-surgery payment may be made, but co-surgeons and team surgery are not permitted.
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.
1,7132001F,,Weight record,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
1,7142002F,,Clin sign vol ovrld 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
1,7152004F,,Initial exam involved joints,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
1,71620100,,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
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915