CPT code 95056: Phototesting, skin response to light2026 Medicare rate & RVUs in California
Reports diagnostic skin testing with controlled light exposure to evaluate suspected photosensitivity, such as a light-triggered rash or other photodermatosis.
Medicare pays $56.37–$74.05 for 95056 in the office in California, from Chico, CA to San Benito County, CA. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 95056 covers
Phototesting evaluates how skin responds to controlled exposure to ultraviolet or visible light. Dermatologists and clinicians experienced in photodermatology use it when a patient develops a rash or other skin reaction in sun-exposed areas and the cause may be abnormal light sensitivity. The test can help characterize the response to light as part of evaluating a suspected photodermatosis.
Choose this code for direct light-response testing, not for applying allergens and then exposing the test site to light. Document the clinical reason for testing, the light-testing method and exposures performed, and the resulting skin response. CMS identifies this as an incident-to service: it is billed only when performed under physician supervision.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 95056 pays more and less in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 payment localities
$56.37 to $74.05
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | $56.42 | Unavailable |
| Chico, CA | $56.37 | Unavailable |
| El Centro, CA | $56.37 | Unavailable |
| Fresno, CA | $56.37 | Unavailable |
| Hanford, CA | $56.37 | Unavailable |
| Los Angeles, CA | $60.90 | Unavailable |
| Madera, CA | $56.37 | Unavailable |
| Marin County, CA | $72.36 | Unavailable |
| Merced, CA | $56.37 | Unavailable |
| Modesto, CA | $56.37 | Unavailable |
| Napa, CA | $67.69 | Unavailable |
| Oxnard, CA | $60.82 | Unavailable |
| Redding, CA | $56.37 | Unavailable |
| Rest of California | $56.37 | Unavailable |
| Riverside, CA | $56.58 | Unavailable |
| Sacramento, CA | $59.79 | Unavailable |
| Salinas, CA | $59.59 | Unavailable |
| San Benito County, CA | $74.05 | Unavailable |
| San Diego, CA | $61.48 | Unavailable |
| San Francisco, CA | $72.34 | Unavailable |
| San Luis Obispo, CA | $58.56 | Unavailable |
| Santa Clara County, CA | $73.96 | Unavailable |
| Santa Cruz, CA | $62.45 | Unavailable |
| Santa Maria, CA | $59.94 | Unavailable |
| Santa Rosa, CA | $63.11 | Unavailable |
| Stockton, CA | $56.37 | Unavailable |
| Vallejo, CA | $67.66 | Unavailable |
| Visalia, CA | $56.37 | Unavailable |
| Yuba City, CA | $56.37 | Unavailable |
How the 95056 rate is calculated
Each of 95056’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 95056
RVUs × geographic indexes × conversion factor
Work0.00
0.00 RVUs× 1.000 GPCI
Practice expense1.53
1.53 RVUs× 1.000 GPCI
Malpractice0.02
0.02 RVUs× 1.000 GPCI
Adjusted RVUs
1.5500
Conversion factor
$33.4009
Medicare rate
$51.77
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 95056
The CMS indicators that decide how 95056 is paid alongside other services.
CMS payment indicators · 95056
Phototesting, skin response to light
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 5 | Incident-to service. |
95056 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 95052Photopatch testingLight-dependent contact allergy
- Use 95056 for direct assessment of skin response to light. Use 95052 when allergens are applied and light exposure is part of evaluating a photoallergic contact reaction.
- 95044Patch testingEach separate patch test
- Use 95044 for patch testing to evaluate delayed contact reactions. Use 95056 when the diagnostic test evaluates skin response to light.
- 95004Allergy skin prick testPercutaneous, immediate reaction, per test
- 95004 covers percutaneous testing for immediate allergen sensitivity. It does not describe direct testing of photosensitivity.
95056 billing questions
How does phototesting differ from photopatch testing?
Phototesting assesses the skin’s response to light exposure. Photopatch testing (95052) evaluates whether a contact allergen causes a reaction when combined with light exposure.
Can this code be used for ordinary patch testing?
No. Ordinary patch testing for delayed contact reactions is reported with 95044; 95056 is for direct testing of skin response to light.
Who may perform the service for Medicare billing?
CMS identifies 95056 as an incident-to service and permits billing only when it is performed under physician supervision.
What documentation supports reporting 95056?
Document the suspected photosensitivity, why light testing was performed, the testing method and exposures, and the observed skin response.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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