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See a sample rate comparisonCPT 96921 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); 250 Sq Cm T, Laser Treatment For Inflammatory Skin Disease (Psoriasis); 250 Sq Cm T
| 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 | Moderate |
| Medicare Fee Schedule | $147.97 national non-facility rate (2026) · View Medicare rates for 96921 |
| Medicaid Fee Schedule | $119.655 median of the 8 states in the free preview · View Medicaid rates for 96921 |
National average reimbursement for CPT 96921 by major payers:
$210.85
$221.01
$219.87
$268.26
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CPT 96921
5 of 25 sample ratesHigher to lower in this preview
Trilok Shah
Ascension Medical Group-Fox Valley Wisconsin Inc
$509.66Published rateMark Wainwright
Association Of University Physicians
$357.70Published rateMatthew Atienza
Advocate Health And Hospitals Corporation
$296.85Published rateAlexandra Aaronson
The Board Of Trustees Of The University Of Illinois
$227.39Published rateLaron Phillips
Brightside Medical
$83.68Published rate
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See a sample payer proposalCPT 96921 vs. Other Special Dermatological Procedures Codes
The CPT 96921 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 96921 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 96921. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96921 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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