CPT 96904 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 • 99 - Other POS |
| Common Modifiers | • None • 59 - Distinct Procedural Service • PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments |
| Complexity Level | Low |
National average reimbursement for CPT 96904 by major payers:
$90.84
$86.90
$86.29
$119.90
| 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 96904 | ||||||
United | 96904 | $114.33 | 1992961643 - CYNTHIA GORDON | 815174138 - (IL) ILLINOIS PROFESSIONALS HEALTH PROGR | IL | Psychiatry Physician (2084P0800X) |
United | 96904 | $126.26 | 1730246067 - SENADA BAJMAKOVIC-KACILA | 911780160 | IL | Psychiatry Physician (2084P0800X) |
United | 96904 | $126.26 | 1952569758 - CHARLES HEBERT | 911780160 | CO | Psychiatry Physician (2084P0800X) |
United | 96904 | $134.32 | 1245252303 - MARY FAHRMEIER | 910844563 | IL | Psychiatry Physician (2084P0800X) |
United | 96904 | $100.91 | 1679739395 - BETSY OSTRANDER | 810232122 - BENEFIS HOSPITALS INC | UT | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 96904 | $78.87 | 1386755486 - DOUGLAS NORDLI | 364340137 - (IL) SAINT ANTHONY HEALTH AFFILIATES | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 96904 | $142.22 | 1780078337 - MATTHEW FILIPPO | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 96904 | $94.62 | 1851825392 - ALEXIA COPENHAVER | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Psychiatry Physician (2084P0800X) |
United | 96904 | $166.72 | 1851558001 - LUBOV ROMANTSEVA | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 96904 | $107.29 | 1447392840 - NISHAD NADKARNI | 364138353 - (IL) ADVENTIST HEALTH PARTNERS INC. | IL | Psychiatry Physician (2084P0800X) |
United | 96904 | $94.62 | 1205125473 - KELLEY VOLPE | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Psychiatry Physician (2084P0800X) |
United | 96904 | $78.12 | 1437438249 - KAPIL AEDMA | 430957840 - SWOPE HEALTH SERVICES | MO | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 96904 | $168.08 | 1194049676 - TRACY BINIUS | 410991680 - FAIRVIEW HEALTH SERVICES | IL | Psychiatry Physician (2084P0800X) |
United | 96904 | $94.62 | 1073697132 - FEDRA NAJJAR | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 96904 | $109.31 | 1326579756 - TONY TU | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | 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 96904 vs. Other Special Dermatological Procedures Codes
The CPT 96904 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 96904 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 |
| 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 96904. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96904 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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