CPT 96900 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | • Medicine Services and Procedures • Special Dermatological Procedures |
| Common Place of Service | • 11 - Office • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments • 59 - Distinct Procedural Service |
| Complexity Level | Low |
National average reimbursement for CPT 96900 by major payers:
$31.42
$27.27
$29.07
$36.88
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 96900 | ||||||
United | 96900 | $52.87 | 1184116253 - VERONICA KRULL | 262998718 | OR | Diagnostic Radiology Physician (2085R0202X) |
United | 96900 | $22.74 | 1578514410 - MICHAEL KASOTAKIS | 351471864 - X-RAY CONSULTANTS, INC. | MI | Diagnostic Radiology Physician (2085R0202X) |
United | 96900 | $22.74 | 1992892608 - MARGARET CLARK | 271414237 - INDIANA REGIONAL IMAGING, P.C. | PA | Diagnostic Radiology Physician (2085R0202X) |
United | 96900 | $23.88 | 1114953841 - WERNER JU | 471108040 | CA | Dermatology Physician (207N00000X) |
United | 96900 | $22.21 | 1982802245 - AARON CETNER | 815095434 | MI | MOHS-Micrographic Surgery Physician (207ND0101X) |
United | 96900 | $40.49 | 1326026964 - ROBERT HEYD | 263513000 - PLAINS RADIOLOGY SERVICES, P.C. | NE | Diagnostic Radiology Physician (2085R0202X) |
United | 96900 | $22.07 | 1639117914 - STEVEN POSNICK | 611654232 - WESTERN NEW YORK MEDICAL PRACTICE PC | NY | Orthopaedic Surgery Physician (207X00000X) |
United | 96900 | $53.60 | 1760975239 - KATHARYN CASSELLA | 621855535 | TN | Diagnostic Radiology Physician (2085R0202X) |
United | 96900 | $35.87 | 1386615672 - STACEY HUDSON | 134237625 - SAF HUDSON, M.D. | NV | Otolaryngology Physician (207Y00000X) |
United | 96900 | $22.41 | 1417120601 - HUMZA ILYAS | 540911387 - DERMATOLOGY ASSOCIATES, INC. | GA | MOHS-Micrographic Surgery Physician (207ND0101X) |
United | 96900 | $88.89 | 1588157762 - ESTHER BARANOV | 43466314 - MASS GENERAL BRIGHAM INCORPORATED | MA | Anatomic Pathology Physician (207ZP0101X) |
United | 96900 | $16.16 | 1215955976 - DAVID JOHNSEN | 260771274 - CENTRA MEDICAL GROUP SOUTHSIDE LLC | VA | Diagnostic Radiology Physician (2085R0202X) |
United | 96900 | $25.31 | 1831308170 - RYAN DUNCAN | 621483206 - HERITAGE MEDICAL ASSOCIATES, P.C. | TN | Otolaryngology Physician (207Y00000X) |
United | 96900 | $45.41 | 1548223001 - CHRISTINE BLIVEN | 840438224 - PORTERCARE ADVENTIST HEALTH SYSTEM | CO | Diagnostic Radiology Physician (2085R0202X) |
United | 96900 | $37.53 | 1194017749 - LULU HE | 271939478 | PA | Diagnostic Radiology Physician (2085R0202X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 96900 vs. Other Special Dermatological Procedures Codes
The CPT 96900 code is part of the Medicine Services and Procedures services used for Special Dermatological Procedures. 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 96900 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 |
|---|---|---|
| 96567-CPT | Low | Photodynamic Therapy By External Application Of Light To Destroy Premalignant Lesions Of The Skin And Adjacent Mucosa With Application And Illumination/Activation Of Photosensitive Drug(S) Per Day (Desc Revised 1/1/2018) |
| 96900-CPT | Low | Actinotherapy (Ultraviolet Light) |
| 96910-CPT | Low | Photochemotherapy; Tar And Ultraviolet B (Goeckerman Treatment) Or Petrolatum And Ultraviolet B |
| 96912-CPT | Low | Photochemotherapy; Puva |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 96900. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96900 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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