Home / Medicare fees / 96935

96935 Rcm img acquisj only ea addl

What 96935 is

CMS fee schedule short descriptor: Rcm img acquisj only ea addl.

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 96935 (CY2026)

Work RVUPractice expense RVUMalpractice RVUTotalMedicare rate
Non-facility (office)0.002.280.002.28$76.15
Facility (hospital, ASC)0.002.280.002.28$76.15

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.


Status: Active - payable under the Physician Fee Schedule. Global period: Add-on code: global period of the primary procedure applies.

Advertisement

Medically Unlikely Edit (MUE)

Medicare caps 96935 at 2 units 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: Clinical: CMS Workgroup. Units above the cap are denied unless the edit's adjudication rules allow an appeal with documentation.

Billed with 96935? These codes are bundled into it

96935 is a Column 1 code in 4 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 codeShort descriptionModifier indicator
76000Fluoroscopy <1 hr phys/qhp1 - modifier may bypassCheck pair
76942Echo guide for biopsy1 - modifier may bypassCheck pair
76998Us guide intraop1 - modifier may bypassCheck pair
96523Irrig drug delivery device0 - no modifier bypassCheck pair

96935 is bundled into these codes

96935 appears as a Column 2 code in 34 active edits. Reported with one of these Column 1 codes on the same date of service, 96935 is the code that denies.

Column 1 codeShort descriptionModifier indicator
0700TMolec fluor img sus nev 1st1Check pair
0701TMolec fluor img sus nev ea1Check pair
11102Tangntl bx skin single les1Check pair
11103Tangntl bx skin ea sep/addl1Check pair
11104Punch bx skin single lesion1Check pair
11105Punch bx skin ea sep/addl1Check pair
11106Incal bx skn single les1Check pair
11107Incal bx skn ea sep/addl1Check pair
11400Exc tr-ext b9+marg 0.5 cm<1Check pair
11401Exc tr-ext b9+marg 0.6-1 cm1Check pair
11402Exc tr-ext b9+marg 1.1-2 cm1Check pair
11403Exc tr-ext b9+marg 2.1-3cm1Check pair
11404Exc tr-ext b9+marg 3.1-4 cm1Check pair
11406Exc tr-ext b9+marg >4.0 cm1Check pair
11420Exc h-f-nk-sp b9+marg 0.5/<1Check 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.