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 | • Medicine Services and Procedures • Special Dermatological 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 |
National average reimbursement for CPT 96902 by major payers:
$30.10
$28.29
$27.91
$35.16
| 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 96902 | ||||||
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 Special Dermatological Procedures Codes
The CPT 96902 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 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 | 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 Photography For Monitoring Of High Risk Patients With Dysplastic Nevus Syndrome Or A History Of Dysplastic Nevi Or Patients With A Personal Or Familial History Of Melanoma |
| 96920-CPT | Low | Laser Treatment For Inflammatory Skin Disease (Psoriasis); Total Area Less Than 250 Sq. Cm |
| 96931-CPT | Moderate | Reflectance Confocal Microscopy (Rcm) For Cellular And Sub-Cellular Imaging Of Skin; Image Acquisition 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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