CPT 96902 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 | Special Dermatological Procedures Medicine Services and Procedures |
| Common Place of Service | 11 - Office 81 - Independent Laboratory 22 - On Campus Outpatient Hospital |
| Common Modifiers | None 52 - Reduced Services 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 96902 |
National average reimbursement for CPT 96902 by major payers:
$30.10
$28.29
$27.91
$32.36
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 96902 | $54.22 | 1578957676 - LAURA VERNON | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | NY | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 96902 | $24.20 | 1023112745 - NELDA AKINBILE | 860285857 - EL RIO SANTA CRUZ NEIGHBORHOOD HEALTH CENTER INC | IL | Psychiatry Physician (2084P0800X) |
United | 96902 | $40.54 | 1710061486 - DAVID KEMP | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 96902 | $10.88 | 1710275110 - PRAVESH DEOTALE | 430654872 - ST LOUIS UNIVERSITY | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 96902 | $32.81 | 1053570754 - CHRISTOPHER HOLDEN | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Psychiatry Physician (2084P0800X) |
United | 96902 | $47.70 | 1629177662 - BARBARA TWARDOWSKI | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 96902 | $39.34 | 1811298987 - ROSARIO COSME CRUZ | 911780160 | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 96902 | $27.95 | 1447243241 - MEDEIA GARTEL | 363305449 - (IL) MOUNT SINAI COMMUNITY FOUNDATION | IL | Psychiatry Physician (2084P0800X) |
United | 96902 | $128.30 | 1871912683 - LAUREN SCHUMACHER | 943281673 | CA | Psychiatry Physician (2084P0800X) |
United | 96902 | $42.34 | 1225318181 - SARTHAK MISRA | 911780160 | IL | Psychiatry Physician (2084P0800X) |
United | 96902 | $44.27 | 1447365440 - AYAME TAKAHASHI | 364143823 - SIU PHYSICIANS & SURGEONS INC | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 96902 | $22.63 | 1669467684 - DAVID MILLER | 541383504 - TOWN CENTER ORTHOPAEDIC ASSOCIATES, P.C. | VA | Orthopaedic Hand Surgery Physician (207XS0106X) |
United | 96902 | $29.37 | 1255692794 - MELISSA WAGNER-SCHUMAN | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Psychiatry Physician (2084P0800X) |
United | 96902 | $25.98 | 1578097846 - CHRISTOPHER LOMBARDI | 205566098 | IL | Psychiatry Physician (2084P0800X) |
United | 96902 | $43.45 | 1740201425 - JOSEPH DIVINCENZO | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | WI | Psychiatry Physician (2084P0800X) |
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 96902 vs. Other Medicine Services and Procedures Codes
The CPT 96902 code is part of the Special Dermatological Procedures services used for Medicine Services and 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 96902 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 |
|---|---|---|
| 96902-CPT | Low | Mcrscp Xm Hair Pluck/Clipped, Microscopic Examination Of Hairs Plucked Or Clipped By The Examiner (Excluding Hair Collected By The Patient) To Determine Telogen And Anagen Counts Or Structural Hair Shaft Abnormality |
| 96904-CPT | Low | Whole Body Integumentary Photo, Whole Body Integumentary Photography For Monitoring Of High Risk Patients With Dysplastic Nevus Syndrome Or A History Of Dysplastic Nevi Or Patientswith A Personal Or Familial History Of Melanoma |
| 96920-CPT | Low | Laser Treatmn For Inflammat Skin Diseas (Psoriasis); Total Area, Laser Treatment For Inflammatory Skin Disease (Psoriasis); Total Area |
| 96931-CPT | Moderate | Reflectance Confocal Microscop, Reflectance Confocal Microscopy (Rcm) For Cellularand Sub-Cellular Imaging Of Skin Image Acquisiti On And Interpretation And Report First Lesion |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 96902. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96902 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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