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See a sample rate comparisonCPT 96999 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.
Unlisted Special Dermatological Svc Or Proc, Unlisted Special Dermatological Service Or Procedure
| 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 | PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments TC - Technical component |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 96999 |
| Medicaid Fee Schedule | $16.92 median of the 3 states in the free preview · View Medicaid rates for 96999 |
National average reimbursement for CPT 96999 by major payers:
$637.08
$41.54
$67.77
$316.05
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CPT 96999
5 of 25 sample ratesHigher to lower in this preview
Medstar Washington Hospital Center
Washington Hospital Center Corporation
$1,057.95Published rateNortheastern Pennsylvania Health Corporation, Hazleton General Hospital
Northeastern Pennsylvania Health Corporation
$704.17Published rateNew Manna Clg, LLC, Lake Health Beachwood Medical Center
New Manna Clg LLC
$465.73Published rateSlidell Memorial Hospital, Md Imaging Slidell
Slidell Memorial Hospital
$410.04Published rateSouthwest Mississippi Regional Medical Center, Lawrence County Hospital
$227.30Published rate
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See a sample payer proposalCPT 96999 vs. Other Special Dermatological Procedures Codes
The CPT 96999 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 96999 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 |
|---|---|---|
| 96936-CPT | Low | Reflectance Confocal Microscop, Reflectance Confocal Microscopy (Rcm) For Cellularand Sub-Cellular Imaging Of Skin Interpretation And Report Only Each Additional Lesion (List Separately In Addition To Code For Primary Procedure) |
| 96999-CPT | Moderate | Unlisted Special Dermatological Svc Or Proc, Unlisted Special Dermatological Service Or Procedure |
| 97010-CPT | Low | Application Of A Modality To O, Application Of A Modality To One Or More Areas Hot Or Cold Packs Application Of A Modality To One Or More Areas Hot Or Cold |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 96999. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96999 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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