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See a sample rate comparisonCPT 20100 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Exploration Of Penetrating Wound; Neck
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Common Modifiers | None GC - Service performed by resident under supervision 51 - Multiple procedures |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 20100 |
| Medicaid Fee Schedule | View Medicaid rates for 20100 |
National average reimbursement for CPT 20100 by major payers:
$804.75
$816.11
$832.93
$972.44
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CPT 20100
5 of 25 sample ratesHigher to lower in this preview
Texas Endoscopy Centers, LLC, Texas Endoscopy
$1,301.00Published rateSurgery Center Of Chattanooga Lp
$722.00Published rateAlliance Surgery Center At Augusta, LLC
Alliance Surgery Center At Augusta LLC
$500.00Published ratePeachtree Orthopaedic Surgery Center-North, LLC
Peachtree Orthopaedic Surgery Centernorth LLC
$175.00Published rateEndoscopy Associates Of Valley Forge, LLC
Endoscopy Associates Of Valley Forge LLC
$83.00Published rate
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See a sample payer proposalCPT 20100 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 20100 code is part of the Surgery services used for Surgical Procedures on the Musculoskeletal System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 20100 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 20100-CPT | Moderate | Exploration Of Penetrating Wound; Neck |
| 20101-CPT | Moderate | Exploration Of Chest |
| 20102-CPT | Moderate | Explora Of Penetrat Wound (Sepa Proc); Abdom/Flank/B, Exploration Of Penetrating Wound (Separate Procedure); Abdomen/Flank/B |
| 31525-CPT | Moderate | Scope Exam Of Voice Box, Exam Of The Voice Box With A Scope (Laryngoscopy). The Procedure May Include An Exam Of The Airway. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 20100. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 20100 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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