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 | $31.18 | 1205125473 - KELLEY VOLPE | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Psychiatry Physician (2084P0800X) |
United | 96900 | $39.38 | 1023053576 - MARIUSZ WASIK | 831002191 - TEMPLE FACULTY PRACTICE PLAN INC | PA | Anatomic Pathology Physician (207ZP0101X) |
United | 96900 | $24.97 | 1639283922 - TIMOTHY WHITEMAN | 351559439 - VINCENNES RADIOLOGY, INC. | IN | Diagnostic Radiology Physician (2085R0202X) |
United | 96900 | $41.10 | 1326204538 - KIRAN TALEKAR | 464855345 - JEFFERSON UNIVERSITY PHYSICIANS OF NEW JERSEY PC | PA | Diagnostic Radiology Physician (2085R0202X) |
United | 96900 | $88.89 | 1588157762 - ESTHER BARANOV | 43466314 - MASS GENERAL BRIGHAM INCORPORATED | MA | Anatomic Pathology Physician (207ZP0101X) |
United | 96900 | $36.06 | 1003041088 - ANKUR GUPTA | 521495113 - ST PAUL PLACE SPECIALISTS INC | NY | Diagnostic Radiology Physician (2085R0202X) |
United | 96900 | $18.53 | 1669652665 - CHAD PORTER | 824681222 | LA | Diagnostic Radiology Physician (2085R0202X) |
United | 96900 | $25.44 | 1073508735 - KERRI BADEN | 272407629 - COASTAL IMAGING SOLUTIONS, LLC DBA | GA | Diagnostic Radiology Physician (2085R0202X) |
United | 96900 | $27.54 | 1952401267 - CRAIG PERSON | 320442710 | PA | Plastic Surgery Physician (208200000X) |
United | 96900 | $14.84 | 1609067040 - KAMYAR AMINI | 262728187 - KAMYAR AMINI MD A MEDICAL CORPORATION | CA | Otolaryngology Physician (207Y00000X) |
United | 96900 | $36.11 | 1689664534 - CAROLINE HO | 390890676 - ST CROIX REGIONAL MEDICAL CENTER | MN | Diagnostic Radiology Physician (2085R0202X) |
United | 96900 | $13.29 | 1578855300 - WILLIAM STEFFES | 593549147 | FL | Dermatology Physician (207N00000X) |
United | 96900 | $36.61 | 1578536397 - DWIGHT HERON | 851040784 | OH | Radiation Oncology Physician (2085R0001X) |
United | 96900 | $108.64 | 1700316916 - ANDREW WONG | 954395492 | CA | Radiation Oncology Physician (2085R0001X) |
United | 96900 | $68.77 | 1043509680 - MASSIHULLAH HAMIDI | 391696443 - LAKESHORE MEDICAL CLINIC, LTD. | WI | 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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