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See a sample rate comparisonCPT 96920 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.
Laser Treatmn For Inflammat Skin Diseas (Psoriasis); Total Area, Laser Treatment For Inflammatory Skin Disease (Psoriasis); Total Area
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Special Dermatological Procedures |
| Common Place of Service | 11 - Office |
| Common Modifiers | 59 - Distinct Procedural Service 79 - Unrelated procedure - postop period |
| Complexity Level | Low |
| Medicare Fee Schedule | $137.95 national non-facility rate (2026) · View Medicare rates for 96920 |
| Medicaid Fee Schedule | $111.515 median of the 8 states in the free preview · View Medicaid rates for 96920 |
National average reimbursement for CPT 96920 by major payers:
$194.37
$206.96
$208.28
$249.52
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CPT 96920
5 of 25 sample ratesHigher to lower in this preview
Thymur Chaudhry
Sutter Valley Medical Foundation
$729.28Published rateKeith Baldwin
$363.94Published rateSolomon Kim
Integrated Imaging Consultants, LLC
$268.69Published rateLisa Longhofer
Lisa K. Longhofer, Md PLLC
$191.76Published ratePeter Meehan
Pediatric Orthopaedic Associates, P. C.
$149.58Published rate
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See a sample payer proposalCPT 96920 vs. Other Special Dermatological Procedures Codes
The CPT 96920 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 96920 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 |
|---|---|---|
| 96912-CPT | Low | Photochemotherapy; Puva |
| 96920-CPT | Low | Laser Treatmn For Inflammat Skin Diseas (Psoriasis); Total Area, Laser Treatment For Inflammatory Skin Disease (Psoriasis); Total Area |
| 96921-CPT | Moderate | Laser Treatmn For Inflammat Skin Diseas (Psoriasis); 250 Sq Cm T, Laser Treatment For Inflammatory Skin Disease (Psoriasis); 250 Sq Cm T |
| 96922-CPT | Moderate | Laser Treatmn For Inflammat Skin Diseas (Psoriasis); Over 500 Sq, Laser Treatment For Inflammatory Skin Disease (Psoriasis); Over 500 Sq |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 96920. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96920 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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