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See a sample rate comparisonCPT 96904 Fee Schedule
Last Verified: October 2026
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.
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
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Special Dermatological Procedures |
| Common Place of Service | 11 - Office 99 - Other POS |
| Common Modifiers | 59 - Distinct Procedural Service PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments |
| Complexity Level | Low |
| Medicare Fee Schedule | $66.13 national non-facility rate (2026) · View Medicare rates for 96904 |
| Medicaid Fee Schedule | $57.805 median of the 8 states in the free preview · View Medicaid rates for 96904 |
National average reimbursement for CPT 96904 by major payers:
$90.84
$86.90
$86.29
$119.36
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CPT 96904
5 of 25 sample ratesHigher to lower in this preview
Srishti Nangia
$213.17Published rateNicholas Hatzis
$137.00Published rateJohn Mcmillin
Advocate Health And Hospitals Corporation
$118.51Published rateMelissa Chappell
$91.11Published ratePatricia Wright
Town Center Orthopaedic Associates, P.C.
$61.65Published rate
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See a sample payer proposalCPT 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 | 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 |
| 96910-CPT | Low | Photochemothrapy; Tar & Ultravio B (Goeckerman Treatmn) Or Pet, Photochemotherapy; Tar And Ultraviolet B (Goeckerman Treatment) Or Pet |
| 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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