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See a sample rate comparisonCPT 20103 Fee Schedule
Medicare rates as of October 2026
CPT 20103 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
Exploration Of Extremity
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 21Inpatient Hospital 22On Campus Outpatient Hospital |
| Common Modifiers | LTLeft side of body RTRight side of body |
| Hospital Outpatient Group (APC) | APC 5072 - Level 2 Excision/ Biopsy/ Incision and Drainage |
| Surgery Center Payment (ASC) | G2 - Paid separately, from the OPPS relative weight |
| Common Revenue Codes | 04500360Sign up to view all 13 |
| Medicare Fee Schedule | $592.20 national non-facility rate (2026)View Medicare rates for 20103 |
| Medicaid Fee Schedule | $471.16 median of the 8 states in the free previewView Medicaid rates for 20103 |
National average reimbursement for CPT 20103 by major payers:
$679.36
BCBS / Anthem
$755.65
UnitedHealthcare
$800.35
Aetna
$576.89
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 20103.
CPT 20103
5 of 25 sample ratesHigher to lower in this preview
Ku Medwest Ambulatory Surgery Center, LLC
Ku Medwest Ambulatory Surgery Center LLC
$3,122.00Published rateProliance Surgeons Inc Ps, Plastic & Reconstructive Surgeons Asc
Proliance Surgeons, Inc., P.S.
$889.00Published rateSurgery Affiliates, LLC, Pinnacle Surgery Center
Surgery Affiliates LLC
$452.00Published rateEye Institute Surgery Center, LLC
Eye Institute Surgery Center LLC
$326.00Published rateTampa Surgery Center LLC
$204.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 20103 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The table lists codes related to 20103. Select one to see its fee schedule.
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 20103. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 20103 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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Frequently Asked Questions
What APC is CPT 20103 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 20103 to APC 5072 (Level 2 Excision/ Biopsy/ Incision and Drainage). An APC groups outpatient services that Medicare pays at the same base rate.
How does Medicare pay for CPT 20103 in an ambulatory surgery center?
CMS lists CPT 20103 with ASC payment indicator G2: Paid separately, from the OPPS relative weight.
Which revenue codes are billed with CPT 20103?
Hospital price transparency files list CPT 20103 under these revenue codes: including 0450, 0360, 0981, 0361 and 0761. A revenue code names the hospital department or charge category for the line; it does not change what the service is.