`96913` Photochemotx sev dermatoses

What 96913 is

CMS fee schedule short descriptor: Photochemotx sev dermatoses.

Full CPT long descriptions are licensed by the American Medical Association and are not published on this site; the short descriptor above is the one CMS prints in its own fee schedule file. See About CPT.

Medicare payment for 96913 (CY2026)

	Work RVU	Practice expense RVU	Malpractice RVU	Total	Medicare rate
Non-facility (office)	0.00	4.38	0.03	4.41	$147.30
Facility (hospital, ASC)	0.00	4.38	0.03	4.41	$147.30

National rates: total RVUs x the CY2026 conversion factor of 33.4009 (non-QP), before geographic adjustment. Actual Medicare payment is 80% of the rate shown after the deductible; the patient or secondary payer owes the 20% coinsurance.

Adjust for a Medicare locality:

Status: Active - payable under the Physician Fee Schedule. Global period: Global concept does not apply.

Medically Unlikely Edit (MUE)

Medicare caps 96913 at 1 unit per date of service for practitioner claims (MAI 3 - date of service edit (clinical): units above the MUE may pay with documentation on appeal), rationale: Nature of Service/Procedure. Units above the cap are denied unless the edit's adjudication rules allow an appeal with documentation.

Billed with 96913? These codes are bundled into it

96913 is a Column 1 code in 11 active NCCI PTP edits. When one of these Column 2 codes is reported on the same date of service, it is denied as bundled - unless the edit's modifier indicator is 1 and documentation supports a distinct service with an NCCI-associated modifier.

Column 2 code	Short description	Modifier indicator
`0906T`	Coms ther 1st appl<=50 sq cm	1 - modifier may bypass	Check pair
`36591`	Draw blood off venous device	0 - no modifier bypass	Check pair
`36592`	Collect blood from picc	0 - no modifier bypass	Check pair
`96523`	Irrig drug delivery device	0 - no modifier bypass	Check pair
`97028`	Ultraviolet therapy	0 - no modifier bypass	Check pair
`99211`	Off/op est may x req phy/qhp	0 - no modifier bypass	Check pair
`99212`	Office o/p est sf 10 min	1 - modifier may bypass	Check pair
`99213`	Office o/p est low 20 min	1 - modifier may bypass	Check pair
`99214`	Office o/p est mod 30 min	1 - modifier may bypass	Check pair
`99215`	Office o/p est hi 40 min	1 - modifier may bypass	Check pair
`G0463`	Hospital outpt clinic visit	1 - modifier may bypass	Check pair

96913 is bundled into these codes

96913 appears as a Column 2 code in 5 active edits. Reported with one of these Column 1 codes on the same date of service, 96913 is the code that denies.

Column 1 code	Short description	Modifier indicator
`96567`	Pdt dstr prmlg les skn	1	Check pair
`96573`	Pdt dstr prmlg les phys/qhp	1	Check pair
`96574`	Dbrdmt prmlg les w/pdt	1	Check pair
`96910`	Photchmtx tar&uvb/ptrltm&uvb	1	Check pair
`96912`	Photochemotherapy puva	1	Check pair

Data: CMS CY2026 Physician Fee Schedule RVU file (October release, RVU26D) and Medicare NCCI PTP practitioner edits v32.3 (2026 Q4). Verify against the official files before billing or contracting decisions.