CPT 96920 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 • None |
| Common Modifiers | • None • 59 - Distinct Procedural Service • 79 - Unrelated procedure - postop period |
| Complexity Level | Low |
National average reimbursement for CPT 96920 by major payers:
$194.37
$206.96
$208.28
$256.52
| 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 96920 | ||||||
United | 96920 | $729.28 | 1043660285 - THYMUR CHAUDHRY | 680273974 - SUTTER VALLEY MEDICAL FOUNDATION | IL | Diagnostic Radiology Physician (2085R0202X) |
United | 96920 | $259.21 | 1639438997 - ANTHONY JEDD | 462494918 - INTEGRATED IMAGING CONSULTANTS, LLC | CA | Diagnostic Radiology Physician (2085R0202X) |
United | 96920 | $535.96 | 1073533634 - PETER O'NEILL | 135562308 - NEW YORK UNIVERSITY | NY | Dermatology Physician (207N00000X) |
United | 96920 | $287.26 | 1275898389 - LYNNE NAPATALUNG | 611661781 | AZ | Dermatology Physician (207N00000X) |
United | 96920 | $363.94 | 1255491825 - KEITH BALDWIN | 232743545 | PA | Orthopaedic Surgery Physician (207X00000X) |
United | 96920 | $268.69 | 1811420698 - SOLOMON KIM | 462494918 - INTEGRATED IMAGING CONSULTANTS, LLC | CA | Diagnostic Radiology Physician (2085R0202X) |
United | 96920 | $298.27 | 1649686171 - KYLE SIERRA | 730579285 - MERCY HOSPITAL OKLAHOMA CITY INC | OK | Diagnostic Radiology Physician (2085R0202X) |
United | 96920 | $157.21 | 1154351021 - ASSOCIATES IN RADIATION MEDICINE, PC | 521932669 - ASSOCIATES IN RADIATION MEDICINE, P.C. | MD | Radiation Oncology Physician (2085R0001X) |
United | 96920 | $149.58 | 1558455683 - PETER MEEHAN | 582212065 - PEDIATRIC ORTHOPAEDIC ASSOCIATES, P. C. | GA | Orthopaedic Surgery Physician (207X00000X) |
United | 96920 | $203.51 | 1801090519 - MATTHEW KOEHLER | 464256391 | CA | Dermatology Physician (207N00000X) |
United | 96920 | $296.48 | 1487628269 - EDWARD CALLAWAY | 464855345 - JEFFERSON UNIVERSITY PHYSICIANS OF NEW JERSEY PC | MN | Diagnostic Radiology Physician (2085R0202X) |
United | 96920 | $459.26 | 1205260668 - KEVIN HE | 310983140 - RIVERSIDE RADIOLOGY & INTERVENTIONAL ASSOCIATES, INC. | OR | Diagnostic Radiology Physician (2085R0202X) |
United | 96920 | $152.13 | 1740252725 - VERONICA RUVO | 866007695 - BENSON HOSPITAL CORPORATION | NE | Diagnostic Radiology Physician (2085R0202X) |
United | 96920 | $212.66 | 1043311202 - DAVID RICE | 611604897 | MO | Diagnostic Radiology Physician (2085R0202X) |
United | 96920 | $444.52 | 1588872212 - REORDAN DE JESUS | 591680273 - FLORIDA CLINICAL PRACTICE ASSOCIATION INC | FL | Diagnostic Radiology Physician (2085R0202X) |
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 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 |
| 96913-CPT | Low | Photochemotherapy (Goeckerman And/Or Puva) For Severe Photoresponsive Dermatoses Requiring At Least Four To Eight Hours Of Care Under Direct Supervision Of The Physician (Includes Application Of Medication And Dressings) |
| 96920-CPT | Low | Laser Treatment For Inflammatory Skin Disease (Psoriasis); Total Area Less Than 250 Sq. Cm |
| 96921-CPT | Moderate | Laser Treatment For Inflammatory Skin Disease (Psoriasis); 250 Sq Cm To 500 Sq Cm |
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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