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See a sample rate comparisonCPT 96931 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.
Reflectance Confocal Microscop, Reflectance Confocal Microscopy (Rcm) For Cellularand Sub-Cellular Imaging Of Skin Image Acquisiti On And Interpretation And Report First Lesion
| 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 | 59 - Distinct Procedural Service GY - Notice of Liability Not Issued, Not Required Under Payer Policy. PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $164.67 national non-facility rate (2026) · View Medicare rates for 96931 |
| Medicaid Fee Schedule | $132.205 median of the 8 states in the free preview · View Medicaid rates for 96931 |
National average reimbursement for CPT 96931 by major payers:
$231.71
$215.75
$201.20
$302.64
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CPT 96931
5 of 25 sample ratesHigher to lower in this preview
P. Daniel Le Grange
$1,233.06Published rateJohn Millichap
Pediatric Faculty Foundation In
$337.92Published rateDavid Sholtes
Rush University Medical Center
$294.04Published rateDiane Misch
The Board Of Trustees Of The University Of Illinois
$243.69Published rateAndrew Kulik
Saint Anthony Health Affiliates
$146.38Published rate
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See a sample payer proposalCPT 96931 vs. Other Special Dermatological Procedures Codes
The CPT 96931 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 96931 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 |
|---|---|---|
| 96931-CPT | Moderate | Reflectance Confocal Microscop, Reflectance Confocal Microscopy (Rcm) For Cellularand Sub-Cellular Imaging Of Skin Image Acquisiti On And Interpretation And Report First Lesion |
| 96932-CPT | Low | Reflectance Confocal Microscop, Reflectance Confocal Microscopy (Rcm) For Cellularand Sub-Cellular Imaging Of Skin Image Acquisiti On Only First Lesion |
| 96933-CPT | Low | Rcm Celulr Subcelulr Img Skn, Reflectance Confocal Microscopy Rcm For Cellular And Sub Cellular Imaging Of Skin Interpretation And Report Only First Lesion |
| 96934-CPT | Low | Rcm Celulr Subcelulr Img Skn, Reflectance Confocal Microscopy (Rcm) For Cellular And Sub-Cellular Imaging Of Skin; Image Acquisition And Interpretation And Report Each Additional Lesion (List Separately In Addition To Code For Primary Procedure) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 96931. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96931 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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