CPT code 96920: Excimer laser, under 250 sq cm2026 Medicare rate & RVUs in Massachusetts
Reports excimer laser treatment of psoriasis when the total skin area treated during the session is less than 250 square centimeters.
Medicare pays $143.91–$160.16 for 96920 in the office in Massachusetts, from Rest of Massachusetts to Metropolitan Boston, MA. 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 96920 covers
This service uses an excimer laser to deliver targeted ultraviolet treatment to psoriasis plaques, commonly in patients with localized disease. Dermatologists and other qualified clinicians may perform it in an office setting; typical treatment sites include discrete plaques on the elbows, knees, or scalp. The laser targets affected skin rather than exposing the whole body to phototherapy.
Choose this code when the total psoriasis area treated during the session is under 250 square centimeters; select the sibling area tier when the treated area is larger. Document the sites and measured area treated, along with the treatment performed. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment is restricted, and co-surgeons and team surgery are not permitted.
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 96920 pays more and less in Massachusetts
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Boston, MA | $160.16 | $44.51 |
| Rest of Massachusetts | $143.91 | $41.92 |
How the 96920 rate is calculated
Each of 96920’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 · 96920
RVUs × geographic indexes × conversion factor
Work0.81
0.81 RVUs× 1.000 GPCI
Practice expense3.28
3.28 RVUs× 1.000 GPCI
Malpractice0.04
0.04 RVUs× 1.000 GPCI
Adjusted RVUs
4.1300
Conversion factor
$33.4009
Medicare rate
$137.95
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 96920
The CMS indicators that decide how 96920 is paid alongside other services.
CMS payment indicators · 96920
Excimer laser, under 250 sq cm
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
96920 without 51 · national office
$137.95
Excimer laser, under 250 sq cm
96920-51 · Second procedure: 50%
$68.98
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
96920 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 96921Excimer laser250–500 square centimeters
- Use 96920 for less than 250 square centimeters treated. Code 96921 applies when the total treated area is 250–500 square centimeters.
- 96922Excimer laserMore than 500 sq cm
- Use 96920 for less than 250 square centimeters treated. Code 96922 applies when the total treated area exceeds 500 square centimeters.
- 96910PhototherapyTar or petrolatum with UVB
- Code 96910 describes photochemotherapy with tar or petrolatum and ultraviolet treatment; 96920 is for targeted excimer laser treatment of psoriasis.
- 96912PUVA therapyPsoralen plus UVA
- Code 96912 is PUVA photochemotherapy. Choose 96920 when psoriasis plaques are treated with an excimer laser instead.
96920 billing questions
How do I choose between 96920, 96921, and 96922?
Use the total psoriasis area treated during the session: 96920 is for less than 250 square centimeters, 96921 for 250–500, and 96922 for more than 500.
Does the number of plaques determine the code?
No. Select the code by the total area treated, not by the number of plaques or laser applications. Document the treated sites and area.
Can I report more than one area tier for the same session?
Select the single tier that matches the total area treated during that session; the tiers distinguish the treatment-area ranges.
Does modifier 50 apply when plaques are on both sides of the body?
No. CMS identifies bilateral adjustment as inapplicable to this code, so modifier 50 is inappropriate.
What happens when another procedure is performed in the same session?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and the other procedures are paid at 50%.
What same-day care is included, and can an assistant be paid?
The 0-day global period includes same-day preoperative and postoperative care. Assistant-at-surgery payment is restricted; co-surgeons and team surgery are not permitted.
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
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