CPT code 96910 – Photochemotherapy with tar and UVB

Key takeaways

CPT Code 96910 covers photochemotherapy with coal tar or petrolatum and UVB light, which is the Goeckerman treatment.

PUVA is a different code. 96912 uses psoralen and UVA light, and mixing the two is the most audited error on these claims.

The 2026 Medicare non-facility rate is roughly $29 to $35. Non-facility pays more because it covers the overhead of an office-based phototherapy suite.

The note must record UVB exposure duration, body surface area, tar concentration, patient response, and a physician order. Missing any one of them is the top denial trigger.

Practice management software like Pabau tracks prior authorizations and captures phototherapy documentation at the point of care.

CPT Code 96910: Official descriptor and code details

CPT Code 96910 is the billing code for photochemotherapy that combines coal tar or petrolatum with ultraviolet B light. Dermatology practices bill it for the Goeckerman regimen, most often when treating psoriasis.

The code sits in the Special Dermatological Procedures section of the AMA CPT code set. The AMA CPT Editorial Panel maintains the official descriptor, which reads Photochemotherapy; tar and ultraviolet B (Goeckerman treatment) or petrolatum and ultraviolet B.

The Goeckerman treatment has been used for over a century. Billing staff still confuse 96910 with 96912, because both descriptors open with the word photochemotherapy. The difference is the agent applied to the skin and the light source used. 96910 pairs coal tar or petrolatum with UVB, while 96912 pairs psoralen with UVA.

What Medicare pays for 96910

The 2026 Medicare Physician Fee Schedule (MPFS) sets payment from Relative Value Units (RVUs) and a geographic conversion factor. The national average for 96910 falls in the range below, according to the CMS Physician Fee Schedule lookup tool. Verify your own locality before billing, because geographic adjustment factors vary by MAC jurisdiction.

Non-facility rates are higher because CMS includes practice expense (PE) RVUs for the overhead of running an office-based phototherapy suite. In a hospital outpatient department the facility bills that overhead separately under the OPPS, so the physician receives a lower professional payment.

RVU breakdown

Work RVUs are identical in both settings, so the whole payment difference comes from practice expense. Pull the current work, practice expense, and malpractice values for your MAC locality from the CMS lookup before you submit.

Modifiers that apply to 96910 claims

Modifier selection for 96910 turns on three questions.

• Was a separately identifiable evaluation and management (E&M) service performed on the same day?
• Who administered the treatment, and under whose supervision?
• What does this payer require on a clean claim for phototherapy?

The National Correct Coding Initiative (NCCI) edits govern bundling between 96910 and E&M codes billed on the same date.

Commercial payers may impose modifier requirements beyond Medicare’s, so check each payer’s phototherapy policy before billing. Appending modifier 25 without a separately documented E&M encounter is the most common audit trigger on 96910 claims.

Documentation requirements for a 96910 claim

Incomplete documentation is the leading cause of 96910 claim denials and post-payment audit recoupments. A defensible claim starts in the medical record, so every element below must appear in the visit note before submission.

• UVB exposure duration: Record the exact time, in seconds or minutes, that the patient was exposed to ultraviolet B radiation during the session.
• Body surface area treated: Document which body regions were exposed and the approximate percentage of BSA covered.
• Tar or petrolatum concentration: Specify the formulation applied, including the concentration if a compounded coal tar preparation was used.
• Patient response: Note the patient’s reaction during and after the session, including any erythema, burning, or change in tolerance.
• Physician order: A signed order for the phototherapy course, with the dosing protocol and frequency, must be present in the chart.
• Cumulative dose log: Payers increasingly request cumulative UVB dose records across the treatment course, so maintain a running log per patient.

Missing any of these elements usually produces a medical necessity denial, or a request for additional documentation. Note templates that prompt for each field cut those omissions sharply.

Pabau’s dermatology EMR lets you make each phototherapy field mandatory on the treatment note. The omission then surfaces at the point of care, instead of weeks later at claim review.

The claim also needs a diagnosis that supports medical necessity. Pair 96910 with the ICD-10-CM diagnosis codes the physician documented for the psoriasis or eczema being treated.

Incident-to billing and supervision rules

Dermatology practices frequently delegate phototherapy administration to nurses or medical assistants, which triggers Medicare’s incident-to billing rules. When billing 96910 under the supervising physician’s NPI, the following conditions must be met.

• Direct supervision required: The supervising physician or qualified non-physician practitioner (NPP) must be in the office suite and immediately available during the session. They need not be in the same room, but they must stay on-site.
• Established patient, established plan: Incident-to billing applies only when the treatment is part of a physician-established plan of care. A new patient’s first phototherapy session typically requires direct physician involvement.
• NPP supervision varies by payer: Under Medicare Part B, a physician assistant or nurse practitioner may supervise incident-to services. State law and payer policy decide whether that is allowed, so verify with your MAC.
• State scope-of-practice rules apply: The scope of practice for nurses administering phototherapy varies by state. Confirm that the delegating practitioner’s supervision arrangement complies with state law.

Under CMS incident-to guidance, billing under the physician’s NPI yields the full physician fee schedule rate. Billing under the NPP’s own NPI reduces payment to 85% of that rate. For a high-volume phototherapy practice, the difference compounds quickly. Document the supervision arrangement for each session, not only at the start of a treatment course.

Place of service codes and how they change payment

Place of service (POS) code selection directly affects the rate applied to a 96910 claim. The wrong POS code is a clean claim failure, producing either an automatic denial or an incorrect payment.

POS 11 covers the overwhelming majority of 96910 claims billed by private dermatology practices. If your practice is provider-based or sits inside a hospital system, check whether your location counts as on-campus or off-campus for OPPS purposes. That answer decides the POS code and the payment rate you receive.

Common billing errors and how to avoid them

Most 96910 denials trace back to a small set of recurring errors. Knowing where claims fail lets billing staff build preventive workflows instead of reactive appeals. Pabau validates CPT and ICD-10 code pairs through its Claim.MD clearinghouse integration before a claim reaches the payer.

• Wrong code: 96910 or 96912. Submitting the PUVA code when coal tar and UVB were used, or the reverse, triggers a clinical coding denial. The agent and the light source must match the code selected.
• Missing documentation elements. Claims submitted without a documented UVB dose, BSA treated, or physician order are denied for insufficient documentation on review.
• Incorrect POS code. Billing POS 22 for a private office phototherapy suite results in underpayment, because the facility rate applies instead of the non-facility rate.
• Unbundling E&M without modifier 25. Appending an E&M code on the same date as 96910 without modifier 25 triggers NCCI bundling edits. The same happens when the encounter is not separately documented.
• Incident-to supervision not documented. When nurses administer the treatment, the chart must show that the supervising physician was present in the office suite. An unsigned order with no same-day supervision note is insufficient.
• Missing prior authorization. Several commercial payers require prior authorization for phototherapy courses. Submitting without a valid auth number results in a denial that is difficult to overturn retrospectively.

Categorize your 96910 denials by root cause before you appeal them. Denials on this code cluster around documentation and code selection, so a targeted change to the note template usually beats coder retraining. Run that analysis through your denial management process.

Related CPT codes in the phototherapy family

96910 is one of six codes in the Special Dermatological Procedures phototherapy group. Two facts in the note decide which one applies. The first is whatever was applied to the skin, and the second is the light source used.

The AAPC Codify CPT lookup carries the full descriptor and crosswalk reference for each code in this family.

CPT 96910 vs CPT 96912: The PUVA distinction

CPT 96912 is the PUVA code. It covers photochemotherapy with psoralen, an oral or topical photosensitizing drug, and UVA radiation. The two modalities are not interchangeable for billing.

PUVA needs a longer lead time, because the psoralen is taken one to two hours before treatment. It is used for more refractory disease and carries a different risk profile.

Confirm from the procedure note which light source was used before you select the code. Where the note does not say, query the treating physician rather than defaulting to one code.

How practice management software supports phototherapy billing

Dermatology practices billing 96910 regularly hit two operational problems. Documentation omissions surface only at claim review, and prior authorizations lapse when a phototherapy course runs across several weeks. Software that ties billing to clinical documentation handles both at the workflow level.

• Structured phototherapy note templates: Configurable note templates prompt the clinician for each required element at the point of care. The UVB dose, BSA, tar formulation, and patient response are captured before the session closes.
• Prior authorization tracking: Expiry alerts stop claims from going out after authorization has lapsed. A 20 to 30 session phototherapy course can span two or three authorization periods.
• Cumulative dose logs: Automated session logging keeps a running record of UVB doses delivered, which payers increasingly request on audit. Spreadsheet tracking introduces transcription errors that put the clinical record and the submitted claim out of step.
• Electronic claim submission: Claims sent through the Claim.MD clearinghouse integration are validated for CPT and diagnosis code pairs before they reach the payer. The integration supports 4,000+ US payers and processes electronic remittance advice (ERA), so payments post automatically.

Pabau’s claims software for dermatology connects the clinical note to the claim. The data captured during the phototherapy session populates the claim without re-entry. For a practice running several phototherapy patients per session block, that cuts billing time per claim and lifts the clean claim rate.

Streamline your dermatology billing workflow

Pabau helps dermatology practices track phototherapy documentation, manage prior authorizations, and submit cleaner claims. See how it works for your team.

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Conclusion

96910 is an easy code to identify and an easy one to bill wrong. Practices lose the money on the note rather than on the code choice, through a missing dose entry or a supervision arrangement nobody wrote down.

The durable fix sits in the note template. A phototherapy note that will not close without the dose, body surface area, formulation and patient response stops the denial before it happens. Prevention recovers far more than appeals do.

Book a demo to see how Pabau captures phototherapy documentation and submits 96910 claims from the same patient record.

Continue your research

Need a starting point for dermatology billing compliance? Medical billing compliance essentials covers the documentation standards that apply across dermatology procedure codes.

Managing prior authorizations across a phototherapy course? Insurance eligibility verification workflows explains how to confirm coverage and auth status before each session block.

Want to understand how the clearinghouse fits into your revenue cycle? How medical claims clearinghouses work walks through the submission-to-payment path for CPT claims.

Frequently asked questions