CPT 96910 Article Number: 2025 Billing Guide
CPT 96910 Article Number: 2025 Billing Guide
Medical billing professionals dealing with dermatology treatments must stay informed about changes in CPT codes and payer requirements. In 2025, CPT 96910—used for photochemotherapy—remains a frequently billed procedure. In this comprehensive guide, we’ll dive into the CPT 96910 article number, reimbursement insights, and documentation requirements that revenue cycle teams need to know.
What is CPT Code 96910 in 2025?
CPT code 96910 is defined as: “Photochemotherapy; tar and ultraviolet B (Goeckerman treatment) or petrolatum and ultraviolet B”. This treatment is often used for chronic skin conditions like psoriasis, eczema, and vitiligo. In 2025, there are no major changes to the procedure description, but coding compliance is more tightly enforced.
Source: CMS Coverage Article A53048
Understanding the CPT 96910 Article Number
The Article Number associated with CPT 96910 typically refers to Local Coverage Articles (LCAs) or National Coverage Determinations (NCDs) published by Medicare Administrative Contractors (MACs). These documents outline how and when the code is covered.
For example, Novitas Solutions lists the article number as A53048 for phototherapy services, which includes CPT 96910.
Why Article Numbers Matter
These articles specify medical necessity, diagnosis requirements, documentation standards, and covered indications. Failing to follow them can lead to denials or audits. Always check the correct MAC’s database for your location.
Explore related internal content: Denial Reasons in Dermatology Billing
Medical Necessity for CPT 96910
CMS and commercial payers require precise documentation of medical necessity. This includes:
- Documented skin condition diagnosis (e.g., ICD-10: L40.0 for psoriasis vulgaris)
- Previous failed therapies, such as topical steroids or biologics
- Treatment plan, frequency, and therapeutic response
Learn how to properly document: Medical Necessity Documentation Tips
ICD-10 Codes Commonly Paired with CPT 96910
When billing CPT 96910, use accurate ICD-10 codes based on the condition. Here are frequently accepted codes in 2025:
- L40.0 – Psoriasis vulgaris
- L30.9 – Dermatitis, unspecified
- L20.84 – Intrinsic (allergic) eczema
- L80 – Vitiligo
Who Can Bill CPT 96910?
Only physicians or licensed clinicians (e.g., PAs, NPs, and dermatologists) under state and payer-specific scope-of-practice rules can bill 96910. Aestheticians may not bill this CPT code under CMS guidelines.
Reference: AAPC CPT 96910 Overview
Place of Service (POS) Guidelines
Most photochemotherapy procedures like CPT 96910 are performed in outpatient clinics (POS 11). Documentation must reflect the correct setting. For telehealth services, CPT 96910 is not approved in 2025.
Billing 96910 with Modifiers
When CPT 96910 is performed with other services, proper use of modifiers like 25 or 59 may be needed to differentiate unrelated E/M services. Avoid unbundling unless documentation fully supports the use.
Review CPT Modifier Guidelines: Modifier 25 & 59 Explained
Reimbursement and Payer-Specific Policies
Medicare reimbursement for CPT 96910 varies by region but averages around $50–$70. Private insurers like UnitedHealthcare or Anthem may reimburse differently depending on plan policies and documentation.
Example links:
Tips to Avoid Denials When Billing CPT 96910
To maximize clean claim rates and avoid denials:
- Always include supporting ICD-10 codes
- Reference Article A53048 or your MAC’s equivalent
- Attach chart notes and treatment protocols
- Ensure POS and provider scope match
FAQs: CPT 96910 Billing in 2025
Q: Is CPT 96910 considered chemotherapy?
No, although it’s a photochemotherapy service, it does not fall under oncology chemotherapy billing rules.
Q: Can I use CPT 96910 for vitiligo?
Yes, if medically necessary and well documented, 96910 is reimbursable for vitiligo when supported by ICD-10 L80.
Q: Can an aesthetician bill CPT 96910?
No. Only licensed clinicians recognized by payers can bill 96910.
Conclusion: Stay Compliant, Stay Paid
The CPT 96910 article number is more than a billing tag—it’s your roadmap for clean claims. In 2025, dermatology practices and RCM teams must align with payer guidance, correct coding, and supported documentation to ensure timely reimbursement. Don’t just memorize the code—understand the policy behind it.
Want more CPT tips? Visit cms1500claimbilling.com for more coding clarity and billing strategies.