CPT code 96910 refers to photochemotherapy using tar or petrolatum in combination with ultraviolet B (UV-B) light—also known as Goeckerman treatment. In 2025, accurate billing for this code requires understanding the latest payer updates, coding edits, and documentation requirements. This guide covers what CPT 96910 entails, recent changes in reimbursement, and practical tips for coding success.
What Is CPT Code 96910?
CPT 96910 describes photochemotherapy involving the topical application of tar or petrolatum followed by UV-B light exposure. This treatment is often used for chronic skin conditions such as psoriasis.
- Common diagnoses: Psoriasis (ICD-10 L40.x), eczema, vitiligo, and other phototherapy-responsive conditions.
- Who administers it: Performed under provider supervision, with topical agents applied by medical personnel.
- Treatment duration: Sessions typically last 15–30 minutes and may occur several times per week.
Comparison with related codes:
- 96900: UV-B phototherapy without topical tar or petrolatum.
- 96912: Photochemotherapy with UVA and psoralen (PUVA therapy).
Key 2025 Coding and Billing Updates
In 2025, the CPT descriptor for 96910 remains unchanged. However, payment rules have shifted slightly. CMS has reduced the Medicare conversion factor to $32.36, down from $33.29 in 2024, which may slightly impact reimbursement.
According to the Medicare National Coverage Determination (NCD 250.1), Goeckerman therapy is covered for psoriasis when medically necessary. Documentation must show the condition, the use of a topical agent, and that treatment was administered under supervision.
Important NCCI Edit: CPT 96910 cannot be billed with 99211 for nurse visits on the same day. Medicare considers this part of the bundled service. If a physician provides a separate E/M service, use modifier -25.
Documentation Tips for CPT 96910
To ensure clean claims and reduce denial risk, document the following:
- Medical necessity and diagnosis (e.g., L40.0 for plaque psoriasis).
- Application of tar or petrolatum by a provider or staff.
- Details of the UV-B exposure (e.g., dosage, body area treated).
- Separate notes for any E/M services provided the same day.
For Medicare, treatment exceeding 30 sessions may require documentation of clinical improvement. Be proactive in tracking progress to support ongoing care.
Reimbursement Considerations in 2025
Medicare, Medicaid, and private insurers may have different policies for 96910. For instance, New York Medicaid covers it for cutaneous T-cell lymphoma (CTCL) when provided by a licensed physician.
Ensure accurate claim submission:
- Use proper ICD-10 codes in Box 21E of the CMS-1500 form.
- Include CPT 96910 in Box 24 and link to the correct diagnosis.
- Verify payer-specific rules on prior authorization and frequency limits.
Best Practices for Billing CPT 96910
- Submit only one phototherapy code per session (96900, 96910, or 96912—not combined).
- Always link the correct ICD-10 code to the service provided.
- Use modifiers like -25 or -59 only when appropriate.
- Check payer-specific LCDs and MAC guidelines regularly.
For additional guidance, see our resources on ICD-10 coding tips, common modifiers, and claim denial reasons.
FAQs About CPT 96910
When should CPT 96910 be used?
Use CPT 96910 when tar or petrolatum is applied by a provider and followed by UV-B phototherapy. For UV-B alone, use CPT 96900 instead.
Can I bill CPT 96910 with an office visit?
Only if the visit involves a distinct E/M service by the physician. Add modifier -25 to the E/M code and ensure separate documentation. Routine nurse visits (e.g., 99211) are not separately payable when billing 96910.
Is there a treatment session limit?
Yes. Medicare typically expects no more than 30 sessions unless improvement is documented. Check with payers for policy specifics.
Conclusion
Coding for CPT 96910 in 2025 requires more than just assigning the right code. Ensure documentation supports the use of a topical agent and UV-B light. Be mindful of payer edits and modifiers, and stay updated on reimbursement changes. For more guidance, explore our latest resources on cms1500claimbilling.com to keep your billing clean and compliant.