CPT 96934 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 |
| Common Modifiers | • None • 79 - Unrelated procedure - postop period |
| Complexity Level | Low |
National average reimbursement for CPT 96934 by major payers:
$141.72
$122.84
$128.18
$205.14
| 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 96934 | ||||||
United | 96934 | $163.83 | 1225211600 - JOHN MILLICHAP | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | CO | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 96934 | $158.11 | 1942278973 - SANJAY NIGAM | 370792770 - (IL) HSHS HOLY FAMILY HOSPITAL INC | IL | Psychiatry Physician (2084P0800X) |
United | 96934 | $81.80 | 1982629051 - THOMAS HERRMANN | 363637465 - (IL) HOOPESTON COMMUNITY MEMORIAL HOSPITAL | IL | Psychiatry Physician (2084P0800X) |
United | 96934 | $181.36 | 1518340231 - NAGA GUNTUPALLI | 363167726 - (IL) RIVERSIDE HEALTH SYSTEM | IL | Psychiatry Physician (2084P0800X) |
United | 96934 | $181.00 | 1083979124 - RAHUL SHARMA | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 96934 | $68.83 | 1730214206 - KALYANI GAVINI | 371158318 - (IL) SOUTHERN ILLINOIS HEALTHCARE FOUNDATION INC | MO | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 96934 | $174.61 | 1295152494 - JENNIFER SPRAGUE | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 96934 | $184.63 | 1205831393 - PRITI SINGH | 461302245 - (IL) ASSOCIATES IN PEDIATRIC NEUROLOGY SC | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 96934 | $163.83 | 1689010373 - EWA BIEBER | 364187449 | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 96934 | $192.83 | 1215056296 - LANCE HOLEMON | 911780160 | IL | Psychiatry Physician (2084P0800X) |
United | 96934 | $174.61 | 1003869553 - MALEEHA AHSAN | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 96934 | $197.89 | 1063972404 - MAANASA BANDLA | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | MA | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 96934 | $217.21 | 1447372842 - GEOFFREY LEVIN | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 96934 | $206.72 | 1710206545 - NEIL JARIWALA | 910844563 | IL | Psychiatry Physician (2084P0800X) |
United | 96934 | $166.96 | 1366890857 - STEVEN SHARP | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | TX | 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 96934 vs. Other Special Dermatological Procedures Codes
The CPT 96934 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 96934 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 |
|---|---|---|
| 96567-CPT | Low | Photodynamic Therapy By External Application Of Light To Destroy Premalignant Lesions Of The Skin And Adjacent Mucosa With Application And Illumination/Activation Of Photosensitive Drug(S) Per Day (Desc Revised 1/1/2018) |
| 96931-CPT | Moderate | Reflectance Confocal Microscopy (Rcm) For Cellular And Sub-Cellular Imaging Of Skin; Image Acquisition And Interpretation And Report, First Lesion |
| 96932-CPT | Low | Reflectance Confocal Microscopy (Rcm) For Cellular And Sub-Cellular Imaging Of Skin; Image Acquisition Only, First Lesion |
| 96934-CPT | Low | 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 96934. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96934 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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