Boost Derma Billing: CPTs 96910, 96912, 96920 Clarity Now!

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Your Essential 2025 Guide to Dermatological Procedure Coding & Reimbursement

Navigating the complexities of CPT codes for specialized dermatological procedures is crucial for accurate billing and optimal reimbursement. This guide provides an updated overview of key ultraviolet light therapy, photochemotherapy, and laser treatment codes for 2025, including CPT codes 96900, 96910, 96912, 96913, 96920, 96921, 96922, 96567, and 96999. We’ll explore their descriptions, common uses, and important considerations for the upcoming year.

Disclaimer: CPT®, HCPCS, RVU values, and payer policies change regularly. This information is for educational purposes as of late 2024/early 2025 and is not a substitute for official 2025 AMA CPT® manuals, CMS NCDs/LCDs, the Medicare Physician Fee Schedule (MPFS), and individual payer policies. Always verify with primary sources.

Ultraviolet Light Therapy (Actinotherapy) CPT Code: 96900

CPT Code 96900: Actinotherapy (ultraviolet light)

Description (2025 Outlook): CPT code 96900 describes actinotherapy, which is the therapeutic use of non-ionizing radiation, specifically ultraviolet (UV) light, without the contemporaneous application of photosensitizers like tar, petrolatum, or psoralens. This typically refers to UVB therapy (broadband or narrowband) administered under medical supervision.

Common Uses: Frequently used as a first-line or adjunctive treatment for various dermatological conditions, including:

Psoriasis (mild to moderate, or widespread)
Atopic dermatitis (eczema)
Vitiligo (especially for repigmentation)
Other photoresponsive dermatoses like pityriasis rosea or lichen planus in some cases.

Comparison to Other Phototherapy Codes:

Unlike CPT 96910, actinotherapy (96900) does not involve the application of tar or petrolatum immediately before UV exposure.
Unlike CPT 96912 (PUVA), actinotherapy (96900) does not involve the use of psoralens (oral or topical) to sensitize the skin to UVA light.
96900 represents a simpler form of UV light treatment compared to the photochemotherapy codes.

Billing Tip (2025):

Ensure documentation specifies the type of UV light used (e.g., narrowband UVB, broadband UVB) and the medical necessity for the treatment.
Accurate recording of the treatment parameters (e.g., dosage, duration) is important.
Verify payer policies, as some may have specific frequency limits or require documentation of failure of topical treatments before approving phototherapy.
This code is generally for in-office procedures under medical supervision.

Photochemotherapy CPT Codes: 96910, 96912, 96913

Photochemotherapy involves the use of a photosensitizing agent in conjunction with light therapy.

CPT Code 96910: Photochemotherapy; tar and ultraviolet B (Goeckerman treatment) or petrolatum and ultraviolet B.

Description (2025 Outlook): This code continues to describe photochemotherapy where topical tar or petrolatum is applied, followed by exposure to ultraviolet B (UVB) light. The short description for this code was noted as changed for January 1, 2025, so refer to the official 2025 CPT manual for the precise wording.

Common Uses: Primarily for severe psoriasis, but may be considered for other photoresponsive dermatoses.

Billing Tip: Documentation is key. Notes should include the application of the photosensitizing agent (tar or petrolatum) by clinical staff if performed in-office. RVUs for 96910 historically considered supplies and direct clinical staff involvement.

CPT Code 96912: Photochemotherapy; psoralens and ultraviolet A (PUVA).

Description (2025 Outlook): This code is used for PUVA therapy, which involves the administration of psoralens (oral or topical) followed by exposure to ultraviolet A (UVA) light.

Common Uses: Severe psoriasis, vitiligo, cutaneous T-cell lymphoma (mycosis fungoides), atopic dermatitis, and other severe photoresponsive dermatoses.

Billing Tip: If topical psoralens are applied by the patient outside the office, CPT code 96900 (Actinotherapy) might be more appropriate as the requirements for 96912 (in-office application/supervision of the photosensitizer) may not be met.

CPT Code 96913: Photochemotherapy (Goeckerman and/or PUVA) for severe photoresponsive dermatoses requiring at least four to eight hours of care under direct supervision of the physician (includes application of medication and dressings).

Description (2025 Outlook): This code is for intensive, prolonged photochemotherapy services requiring extensive, directly supervised physician care over several hours. The short description for this code was also noted as changed for January 1, 2025; consult the official 2025 CPT manual.

Common Uses: Very severe and extensive photoresponsive dermatoses requiring intensive, day-long treatment protocols.

Billing Tip: This code is rarely used and often subject to strict payer scrutiny due to the intensive care requirements. Documentation must robustly support the necessity of 4-8 hours of direct physician supervision.

Laser Treatment CPT Codes: 96920, 96921, 96922 – BIG CHANGES FOR 2025!

These codes are used for laser treatments of skin conditions, differentiated by the treated surface area.

Significant 2025 Update: The AMA CPT Editorial Panel has accepted revisions to CPT codes 96920-96922. Previously primarily indicated for psoriasis, their descriptors are being expanded to include “inflammatory and autoimmune skin conditions.” This will now more explicitly cover conditions like:

Vitiligo
Atopic Dermatitis
Mycosis Fungoides
Lichen Planus
Alopecia Areata
Cutaneous T-Cell Lymphoma (CTCL)

This revision aims to align with FDA clearances and commercial payer guidelines, potentially streamlining authorizations and reducing denials for these conditions. Some information also suggests the CPT Editorial Panel accepted revisions to delete “Excimer” from these codes to remove laser type limitations, effective January 2027, though this specific effective date and detail should be verified with the final 2025 CPT publications and any subsequent AMA updates.

CPT Code 96920: Laser treatment for inflammatory skin disease; total area less than 250 sq cm.

CPT Code 96921: Laser treatment for inflammatory skin disease; 250 sq cm to 500 sq cm.

CPT Code 96922: Laser treatment for inflammatory skin disease; over 500 sq cm.

Billing Tip (2025): With the expanded indications, ensure your documentation clearly specifies the condition being treated (e.g., vitiligo, atopic dermatitis, in addition to psoriasis) and accurately measures and records the total surface area treated to select the correct code. Stay updated on payer policies regarding these expanded indications as they implement the 2025 CPT changes.

Other Relevant Dermatological Procedure CPT Codes for 2025

CPT Code 96567: Photodynamic therapy (PDT) by external application of light to destroy premalignant and/or malignant lesions of the skin and adjacent mucosa with application and illumination/activation of photosensitive drug(s), per day.

Description (2025 Outlook): Used for PDT where a photosensitizing drug is applied topically, followed by light activation to treat lesions like actinic keratoses.

Billing Tip: Often used with specific J-codes for the photosensitizing drug (e.g., J7308 for aminolevulinic acid HCl). Ensure documentation supports the medical necessity of PDT and the specific drug used.

CPT Code 96999: Unlisted special dermatological service or procedure.

Description (2025 Outlook): This code should be used when a specific CPT code does not exist to describe the dermatological service or procedure performed.

Common Uses (Historically & Potentially for 2025 if specific codes are still lacking for certain new laser applications or other unique procedures): Previously, it was sometimes used for excimer laser treatment for vitiligo before the 2025 CPT changes to 96920-96922 more clearly included it. It remains the code for truly novel or unlisted procedures.

Billing Tip: Requires very detailed documentation submitted with the claim, including a clear description of the procedure, why it was necessary, the time and effort involved, and any equipment used. Comparative CPT codes can sometimes be helpful in payer communications.

Key Considerations for 2025 Dermatology Billing & Reimbursement

Medicare Physician Fee Schedule (MPFS) Conversion Factor: The MPFS Conversion Factor (CF) is updated annually by CMS and impacts overall Medicare reimbursement. For CY 2025, CMS proposed a CF of $32.36, a decrease from the 2024 CF. The AADA has expressed concerns about ongoing cuts and advocates for payment stability. Always refer to the final 2025 MPFS for the official CF.
Payer Policies are Paramount:
- While CPT codes define procedures, reimbursement is governed by individual payer medical policies (Medicare NCDs/LCDs, commercial payer policies). These policies outline covered diagnoses, medical necessity criteria, documentation requirements, and any prior authorization needs.
- Searches for BCBSNC and Anthem indicate they have policies related to phototherapy and laser treatments, but these policies are subject to frequent updates. It is essential to check the current 2025 policies directly with each specific payer.
- The 2025 expansion of CPT codes 96920-96922 will require payers to update their policies. Monitor these updates closely.
Documentation: Thorough and accurate documentation remains the cornerstone of successful billing. Ensure your records clearly support the medical necessity of the chosen procedure, the specifics of the service provided (e.g., type of phototherapy, photosensitizer used, laser parameters, total area treated), and any direct physician supervision as required by code definitions.
NCCI Edits & Bundling: Be aware of National Correct Coding Initiative (NCCI) edits and payer-specific bundling rules. Such edits can change, so always verify current bundling logic.
HCPCS Codes for Supplies/Drugs/Equipment: Remember to use appropriate HCPCS codes for any supplied photosensitizing drugs (e.g., J-codes like J7308), or for home phototherapy equipment if applicable (e.g., E0691-E0694). Verify these against the 2025 HCPCS code set.

Staying Updated in 2025:

To ensure compliance and optimize reimbursement in 2025:

Obtain the official 2025 CPT® Manual from the AMA.
Review the Final 2025 Medicare Physician Fee Schedule (MPFS) from CMS.
Regularly check the websites of your major payers (including Medicare MACs, BCBS, Anthem, etc.) for their most current 2025 medical policies related to these dermatological procedures.
Subscribe to updates from dermatological societies (e.g., AAD) which often provide analyses of coding and reimbursement changes.

By staying informed and adhering to precise coding and documentation standards, dermatology practices can navigate the 2025 landscape effectively.

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