CPT 96921 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 | Moderate |
National average reimbursement for CPT 96921 by major payers:
$210.85
$221.01
$219.87
$276.64
| 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 96921 | ||||||
United | 96921 | $362.01 | 1225211600 - JOHN MILLICHAP | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | CO | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 96921 | $227.39 | 1881937928 - ALEXANDRA AARONSON | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Psychiatry Physician (2084P0800X) |
United | 96921 | $146.86 | 1730263617 - MARK ALTER | 910844563 | VA | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 96921 | $357.70 | 1063471159 - MARK WAINWRIGHT | 911220843 - ASSOCIATION OF UNIVERSITY PHYSICIANS | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 96921 | $263.07 | 1356608988 - TRIXIE LIPKE | 391157876 - BEAVER DAM COMMUNITY HOSPITALS INC | IL | Psychiatry Physician (2084P0800X) |
United | 96921 | $372.85 | 1285715847 - SHANNON JENNINGS | 362604009 - (IL) OTTAWA REGIONAL HOSPITAL & HEALTHCARE CENTER | CO | Psychiatry Physician (2084P0800X) |
United | 96921 | $348.35 | 1760419311 - PETER HEYDEMANN | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 96921 | $348.35 | 1508922964 - COLLEEN BUHRFIEND | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 96921 | $146.86 | 1114196995 - ANGELA GREEN | 910844563 | IL | Psychiatry Physician (2084P0800X) |
United | 96921 | $417.66 | 1659714806 - RAVI RAMASAMY | 910564748 - SEATTLE CHILDRENS HOSPITAL | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 96921 | $281.60 | 1568533701 - REGINALD GIVENS | 362222696 - SWEDISHAMERICAN HOSPITAL | IL | Psychiatry Physician (2084P0800X) |
United | 96921 | $283.82 | 1740201425 - JOSEPH DIVINCENZO | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | WI | Psychiatry Physician (2084P0800X) |
United | 96921 | $132.17 | 1730214206 - KALYANI GAVINI | 371158318 - (IL) SOUTHERN ILLINOIS HEALTHCARE FOUNDATION INC | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 96921 | $304.52 | 1750680120 - REKHA KASI | 911780160 | IL | Psychiatry Physician (2084P0800X) |
United | 96921 | $342.30 | 1376063370 - ABBY FREDRICKSON | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Psychiatry Physician (2084P0800X) |
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 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 |
|---|---|---|
| 96910-CPT | Low | Photochemotherapy; Tar And Ultraviolet B (Goeckerman Treatment) Or Petrolatum And Ultraviolet B |
| 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) |
| 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 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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