Summary & Overview
CPT 96910: Photochemotherapy (Goeckerman) with Tar or Petrolatum
Headline: CPT 96910: Photochemotherapy (Goeckerman) for Dermatologic Care
Lead: CPT 96910 describes photochemotherapy that pairs topical tar or petrolatum with ultraviolet B (Goeckerman treatment) to manage inflammatory skin diseases. The code is relevant across dermatology practices and outpatient hospital settings where targeted phototherapy is provided.
What the code represents and why it matters: This code captures a specialized phototherapy service used primarily for chronic inflammatory skin conditions. Its inclusion in procedural coding matters for accurate clinical documentation, billing, and appropriate classification of dermatologic outpatient procedures.
Key payers covered: Analysis includes major national payers such as Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare.
What readers will learn: The publication summarizes clinical context for CPT 96910, common billing associations, relevant diagnostic indications, and related procedure codes used in dermatologic phototherapy. It highlights payer coverage relevance and typical site-of-service considerations for outpatient hospital delivery.
Scope and limitations: The content is intended for a national audience. Specific state-level policy or local coverage determinations are not included. Data not available in the input for service line details beyond the provided metadata.
CPT Code Overview
CPT 96910 describes photochemotherapy using tar and ultraviolet B (Goeckerman treatment) or petrolatum and ultraviolet B. This procedure is a dermatologic phototherapy technique combining topical agents (coal tar or petrolatum) with targeted ultraviolet B exposure to treat inflammatory skin conditions.
Service type: Dermatology
Typical site of service: Outpatient Hospital (POS 22)
Clinical & Coding Specifications
Clinical Context
A middle-aged adult with moderate plaque psoriasis presents to an outpatient hospital dermatology clinic for photochemotherapy using topical coal tar plus ultraviolet B (Goeckerman treatment) or petrolatum with ultraviolet B. The clinical workflow begins with a dermatology physician evaluation, documentation of diagnosis and treatment indications, informed consent, and skin assessment. A technologist prepares the treatment area, applies tar or petrolatum as ordered, and delivers controlled UVB exposures in a phototherapy suite. The physician documents the professional component, reviews response at follow-up visits, and adjusts treatment frequency or topical regimen. Billing is performed from the outpatient hospital place of service (POS 22) with separation of professional and technical components as appropriate.
Coding Specifications
Modifier 26 (Professional Component): used when billing only the physician’s professional services related to interpretation, treatment planning, and medical supervision of the photochemotherapy.
Modifier TC (Technical Component): used when billing only the technical services, including equipment, technologist time, and facility resources for delivering the tar + UVB or petrolatum + UVB treatment.
Associated provider taxonomies:
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207N00000X— Dermatology Physician: specialists who evaluate and manage medical dermatologic conditions and direct phototherapy regimens. -
207ND0101X— MOHS-Micrographic Surgery Physician: dermatologic surgeons with training in micrographic procedures; may be involved in skin disease management in specialty practices. -
207NS0135X— Pediatric Dermatology Physician: dermatologists with pediatric expertise who manage phototherapy for children when indicated.
Related Diagnoses
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L40.0— Psoriasis vulgarisClinical relevance: Common indication for photochemotherapy with topical tar plus UVB to reduce inflammation and hyperproliferation of psoriatic plaques.
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L40.8— Other psoriasisClinical relevance: Includes less common psoriasis variants for which Goeckerman or petrolatum plus UVB phototherapy may be considered.
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L40.9— Psoriasis, unspecifiedClinical relevance: Used when psoriasis is documented without a specified subtype; photochemotherapy is a standard treatment option for generalized or recalcitrant disease.
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L56.2— Photocontact dermatitis [berloque dermatitis]Clinical relevance: Represents photoreactive contact dermatitis; phototherapy may be part of diagnostic evaluation or therapeutic management depending on clinical course.
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L56.8— Other specified acute skin changes due to ultraviolet radiationClinical relevance: Captures acute UV-related skin changes that may prompt evaluation of UV exposure and consideration of controlled phototherapy as part of treatment planning.
Related CPT Codes
| CPT Code | Description |
|---|---|
96900 | Actinotherapy (ultraviolet light) |
96912 | Photochemotherapy; psoralens and ultraviolet A (PUVA) |
96913 | Photochemotherapy; psoralens with ultraviolet A (PUVA), bath |
96920 | Laser treatment for inflammatory skin disease (psoriasis) |
96921 | Laser treatment for inflammatory skin disease (psoriasis), more than 250 cm2 |
96900 is an alternative actinotherapy code for ultraviolet light treatments without the topical tar or petrolatum components. 96912 and 96913 describe systemic or bath psoralen plus UVA (PUVA) photochemotherapy, representing pharmacologic photochemotherapy alternatives. 96920 and 96921 are laser-based treatments for psoriasis used in different clinical scenarios; they may be alternatives when topical photochemotherapy is not appropriate or as adjunctive therapy. Codes may be used in the same clinical workflow as alternatives based on treatment modality; combinations should be billed according to payer rules and component separation when applicable.
National Reimbursement Benchmarks
National commercial averages (BUCA) sit modestly above Medicare mean rates for 96910: the BUCA mean is $138.53 versus the Medicare mean of $120.37, a difference of $18.16. UnitedHealth Group and Cigna report the highest commercial mean rates, with UnitedHealth Group at $174.93 and Cigna at $163.59, while Aetna and Medicare are lower on the mean spectrum.
Dispersion across payers varies: UnitedHealth Group and Cigna display the widest interquartile ranges (UHC: $220.25 - $102.00 = $118.25; Cigna: $206.50 - $98.00 = $108.50), indicating greater variability in allowed amounts. Medicare and Aetna are among the tightest (Medicare: $126.00 - $109.00 = $17.00; Aetna: $131.00 - $76.00 = $55.00). The table and chart below present the full breakdown of mean rates and percentiles by payer.
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