Summary & Overview
CPT 97028: Ultraviolet Therapy Application in Physical Medicine
CPT code 97028 represents the application of ultraviolet therapy to one or more areas, a modality frequently used in physical medicine and rehabilitation. This procedure is primarily delivered in office settings and is integral to the management of certain dermatological and musculoskeletal conditions. Ultraviolet therapy is recognized for its clinical value in treating disorders such as psoriasis, dermatitis, and actinic keratosis, among others.
The publication covers key national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare. Readers will gain insights into payer coverage policies, relevant clinical indications, and associated billing practices for ultraviolet therapy. The analysis includes benchmarks for utilization, updates on policy changes, and context for how this service fits within broader physical medicine and rehabilitation offerings.
Additionally, the summary provides an overview of common modifiers, associated provider taxonomies, and related CPT codes, equipping stakeholders with a comprehensive understanding of the procedural, clinical, and administrative landscape for CPT code 97028. This information is essential for healthcare professionals, billing specialists, and policy analysts seeking to navigate the complexities of medical coding and reimbursement for ultraviolet therapy.
CPT Code Overview
CPT code 97028 is used to report the application of a modality to one or more areas, specifically ultraviolet therapy. This procedure is commonly performed as part of Physical Medicine and Rehabilitation services. The typical site of service for this code is the office setting (Place of Service 11). Ultraviolet therapy is utilized to treat various dermatological and musculoskeletal conditions, providing targeted exposure to ultraviolet light as part of a therapeutic regimen.
Clinical & Coding Specifications
Clinical Context
A patient presents to a physical medicine and rehabilitation clinic with chronic skin conditions such as psoriasis or dermatitis. The provider, typically a physical therapist or rehabilitation practitioner, evaluates the affected areas and determines that ultraviolet therapy is appropriate. The procedure involves the application of ultraviolet light to one or more areas of the skin to reduce inflammation, promote healing, or manage symptoms. The service is performed in an office setting (Place of Service 11), and may be repeated as clinically indicated. Documentation includes the indication for therapy, areas treated, duration, and response to treatment.
Coding Specifications
-
Modifier
59: Used to indicate a distinct procedural service, meaning the ultraviolet therapy (97028) is separate from other procedures performed on the same day. -
Modifier
76: Used when the same procedure (97028) is repeated by the same provider during the same encounter or on the same day.
| Modifier Code | Description |
|---|---|
59 | Distinct Procedural Service |
76 | Repeat Procedure or Service by Same Provider |
- Provider Taxonomies:
| Taxonomy Code | Specialty |
|---|---|
225100000X | Physical Therapist |
225200000X | Physical Therapy Assistant |
225400000X | Rehabilitation Practitioner |
These taxonomies represent professionals qualified to perform physical medicine modalities, including ultraviolet therapy.
Related Diagnoses
-
L30.9- Dermatitis, unspecified- Relevant for patients with non-specific skin inflammation treated with ultraviolet therapy.
-
L40.0- Psoriasis vulgaris- Ultraviolet therapy is a standard treatment for psoriasis to reduce plaques and inflammation.
-
L56.2- Photocontact dermatitis [berloque dermatitis]- Ultraviolet therapy may be used for certain photodermatitis cases to modulate immune response.
-
L57.0- Actinic keratosis- Ultraviolet therapy can be applied to precancerous skin lesions for therapeutic purposes.
-
L58.9- Radiodermatitis, unspecified- Used for patients with skin changes due to radiation exposure, where ultraviolet therapy aids healing.
Related CPT Codes
97032- Electrical stimulation (manual), to one or more areas, each 15 minutes
97032 is another physical medicine modality that may be used in conjunction with or as an alternative to ultraviolet therapy (97028). In clinical workflows, both codes can be billed if distinct procedures are performed, often supported by modifier 59 to indicate separate services. These modalities are commonly used to address different aspects of rehabilitation and symptom management.
National Reimbursement Benchmarks
Medicare's national mean rate for CPT 97028 is $8.67, which is lower than the BUCA (Blue Cross Blue Shield, UnitedHealthcare, Cigna, Aetna) average commercial mean rate of $9.81. Among individual commercial payers, Blue Cross Blue Shield has the highest mean rate at $12.89, while Aetna is the lowest at $6.37.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. Medicare shows the tightest range at $1.00, indicating minimal variation in rates. In contrast, Cigna and Blue Cross Blue Shield exhibit the widest dispersions, with ranges of $7.00 and $5.50 respectively, reflecting greater variability in commercial reimbursement.
The table and chart below present a detailed breakdown of national mean rates and percentile values for each payer.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska's reimbursement rates for CPT code 97028 show a substantial spread across payers, with Blue Cross Blue Shield exhibiting the widest range between the 25th and 75th percentiles ($12.50), while UnitedHealth Group's rates are tightly clustered at $20.00 for all percentiles. Compared to national averages, Alaska's commercial payers consistently offer higher mean rates, often nearly double those seen nationwide, highlighting a premium market for this code in the state.
The table and chart below present the full breakdown of mean rates and percentile values for each payer in Alaska, allowing for direct comparison of reimbursement levels and variability across the major insurers and Medicare.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer for CPT 97028 in Alaska, with a mean rate of $21.23.
- Medicare is the lowest paying payer, with a mean rate of $8.42, notably below the commercial payers.
- All Alaska commercial payer rates are significantly higher than their respective national averages, with mean rates nearly double the national benchmarks.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.