CPT 20102
Global 010 ActiveExpl pentrg wnd abd/flnk/bk
CPT 20102 Billing & Documentation Guide
CPT code 20102 (Expl pentrg wnd abd/flnk/bk) is classified under Surgery (Musculoskeletal) with a global period indicator of 010. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 3.88, a non-facility practice expense RVU of 14.95, and a malpractice RVU of 0.99, a total non-facility RVU of 19.82 and facility RVU of 7.34. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $681.68, though rates vary from $575.56 to $881.63 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 20102, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 20102 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
10-day global period (minor procedure: pre-op day + procedure + 10 days post-op)
MUE Limit (Medically Unlikely Edits)
Submitting more than 3 units of 20102 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 20102
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 3.88 | 3.88 |
| Practice Expense RVU | 14.95 | 2.47 |
| Malpractice RVU | 0.99 | 0.99 |
| Total RVU | 19.82 | 7.34 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 20102
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $743.03 | $249.79 | $696.8 - $881.63 | 29 |
| Florida | $694.98 | $276.74 | $656.67 - $733.04 | 3 |
| Georgia | $645.73 | $248.06 | $614.43 - $677.03 | 2 |
| Illinois | $675.73 | $272.95 | $637.18 - $708.23 | 4 |
| Michigan | $645.02 | $253.61 | $622.83 - $667.21 | 2 |
| North Carolina | $616.61 | $227.7 | $616.61 - $616.61 | 1 |
| New York | $737.76 | $272.74 | $627.22 - $793.01 | 5 |
| Ohio | $618.83 | $238.25 | $618.83 - $618.83 | 1 |
| Pennsylvania | $655.22 | $246.92 | $619.24 - $691.19 | 2 |
| Texas | $652.63 | $242.24 | $614.72 - $687.46 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 20102
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 20102 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0213T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0228T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0230T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0596T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0597T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0903T | Column 1 (primary), can be billed with modifier | Yes | CPT Separate procedure definition |
| 0904T | Column 1 (primary), can be billed with modifier | Yes | CPT Separate procedure definition |
| 0905T | Column 1 (primary), can be billed with modifier | Yes | CPT Separate procedure definition |
| 11000 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
Frequently Asked Questions, CPT 20102
What does CPT code 20102 mean? +
CPT code 20102 represents: Expl pentrg wnd abd/flnk/bk. It's in the Surgery (Musculoskeletal) category with a global period of 010.
What is the Medicare reimbursement for CPT 20102? +
The 2026 Medicare national average non-facility payment for CPT 20102 is $681.68. Rates range from $575.56 to $881.63 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 20102? +
Surgery codes commonly use modifier 22 (increased procedural services), 50 (bilateral), 51 (multiple procedures), 52 (reduced services), 58/78/79 (staged, unplanned return, unrelated within global), 62 (co-surgeons), 80/82 (assistant surgeon), and 59 or the X{EPSU} subset for distinct procedural service.
What bundling edits apply to CPT 20102? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on April 17, 2026.
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