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See a sample rate comparisonCPT 96913 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.
Photochemotx Sev Dermatoses, Photochemotherapy (Goeckerman And/Or Puva) For Severe Photoresponsive Dermatoses Requiring At Least 4-8 Hours Of Care Under Direct Supervision Of The Physician (Includes Application Of Medication And Dressings)
| 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 | PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | $147.30 national non-facility rate (2026) · View Medicare rates for 96913 |
| Medicaid Fee Schedule | $118.365 median of the 8 states in the free preview · View Medicaid rates for 96913 |
National average reimbursement for CPT 96913 by major payers:
$185.18
$166.21
$167.01
$222.61
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CPT 96913
5 of 25 sample ratesHigher to lower in this preview
Tracy Binius
$419.63Published rateMark Alter
$282.55Published rateJames Mackenzie
$268.58Published rateUtpal Dhruve
Advocate Health And Hospitals Corporation
$239.44Published rateAlba Pergjika
$105.33Published rate
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See a sample payer proposalCPT 96913 vs. Other Special Dermatological Procedures Codes
The CPT 96913 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 96913 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 |
|---|---|---|
| 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 |
| 96913-CPT | Low | Photochemotx Sev Dermatoses, Photochemotherapy (Goeckerman And/Or Puva) For Severe Photoresponsive Dermatoses Requiring At Least 4-8 Hours Of Care Under Direct Supervision Of The Physician (Includes Application Of Medication And Dressings) |
| 96920-CPT | Low | Laser Treatmn For Inflammat Skin Diseas (Psoriasis); Total Area, Laser Treatment For Inflammatory Skin Disease (Psoriasis); Total Area |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 96913. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96913 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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