Billing code 95056: PhototestingMedicare rate & RVUs
Reports diagnostic skin testing with controlled light exposure to evaluate suspected photosensitivity, such as a light-triggered rash or other photodermatosis.
Medicare pays $51.77 for 95056 nationally in the office. Local office rates run $44.24–$74.05.
Medicare rate · 95056
Phototesting
Swap in your local Medicare rate.
- Work RVUs
- 0
- Total RVUs
- 1.55
- Global days
- XXX
National rate · 2026
$51.77
Office setting, before claim adjustments.
See every locality for 95056 → · Billed by an NP, PA or therapist? →
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 10 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. The CMS facts provided do not specify separate professional or technical components.
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
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$44.24 to $74.05
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $45.09 | Unavailable |
| Alaska* | $54.79 | Unavailable |
| Arizona | $50.09 | Unavailable |
| Arkansas | $44.24 | Unavailable |
| Atlanta | $52.72 | Unavailable |
| Austin | $54.66 | Unavailable |
| Bakersfield | $56.42 | Unavailable |
| Baltimore/Surr. Cntys | $55.66 | Unavailable |
| Beaumont | $47.12 | Unavailable |
| Brazoria | $51.16 | Unavailable |
| Chicago | $52.89 | Unavailable |
| Chico | $56.37 | Unavailable |
| Colorado | $54.90 | Unavailable |
| Connecticut | $55.85 | Unavailable |
| Dallas | $51.47 | Unavailable |
| Dc + Md/Va Suburbs | $60.94 | Unavailable |
| Delaware | $51.09 | Unavailable |
| Detroit | $50.44 | Unavailable |
| East St. Louis | $48.36 | Unavailable |
| El Centro | $56.37 | Unavailable |
| Fort Lauderdale | $52.98 | Unavailable |
| Fort Worth | $50.97 | Unavailable |
| Fresno | $56.37 | Unavailable |
| Galveston | $51.30 | Unavailable |
| Hanford-Corcoran | $56.37 | Unavailable |
| Hawaii, Guam | $58.49 | Unavailable |
| Houston | $51.66 | Unavailable |
| Idaho | $47.33 | Unavailable |
| Indiana | $47.70 | Unavailable |
| Iowa | $47.02 | Unavailable |
| Kansas | $46.53 | Unavailable |
| Kentucky | $46.04 | Unavailable |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $60.90 | Unavailable |
| Madera | $56.37 | Unavailable |
| Manhattan | $60.44 | Unavailable |
| Merced | $56.37 | Unavailable |
| Metropolitan Boston | $61.61 | Unavailable |
| Metropolitan Kansas City | $48.64 | Unavailable |
| Metropolitan Philadelphia | $54.00 | Unavailable |
| Metropolitan St. Louis | $49.32 | Unavailable |
| Miami | $54.89 | Unavailable |
| Minnesota | $52.78 | Unavailable |
| Mississippi | $44.49 | Unavailable |
| Modesto | $56.37 | Unavailable |
| Montana** | $51.77 | Unavailable |
| Napa | $67.69 | Unavailable |
| Nebraska | $47.42 | Unavailable |
| Nevada** | $51.71 | Unavailable |
| New Hampshire | $53.78 | Unavailable |
| New Mexico | $47.66 | Unavailable |
| New Orleans | $48.85 | Unavailable |
| North Carolina | $48.11 | Unavailable |
| North Dakota** | $51.37 | Unavailable |
| Northern Nj | $59.99 | Unavailable |
| Nyc Suburbs/Long Island | $62.00 | Unavailable |
| Ohio | $47.33 | Unavailable |
| Oklahoma | $46.15 | Unavailable |
| Oxnard-Thousand Oaks-Ventura | $60.82 | Unavailable |
| Portland | $57.27 | Unavailable |
| Poughkpsie/N Nyc Suburbs | $56.77 | Unavailable |
| Puerto Rico | $52.32 | Unavailable |
| Queens | $61.37 | Unavailable |
| Redding | $56.37 | Unavailable |
| Rest Of California | $56.37 | Unavailable |
| Rest Of Florida | $49.86 | Unavailable |
| Rest Of Georgia | $46.38 | Unavailable |
| Rest Of Illinois | $47.70 | Unavailable |
| Rest Of Louisiana | $45.87 | Unavailable |
| Rest Of Maine | $47.43 | Unavailable |
| Rest Of Maryland | $52.33 | Unavailable |
| Rest Of Massachusetts | $54.34 | Unavailable |
| Rest Of Michigan | $47.41 | Unavailable |
| Rest Of Missouri | $44.70 | Unavailable |
| Rest Of New Jersey | $56.54 | Unavailable |
| Rest Of New York | $49.02 | Unavailable |
| Rest Of Oregon | $51.37 | Unavailable |
| Rest Of Pennsylvania | $47.54 | Unavailable |
| Rest Of Texas | $49.10 | Unavailable |
| Rest Of Washington | $54.32 | Unavailable |
| Rhode Island | $53.39 | Unavailable |
| Riverside-San Bernardino-Ontario | $56.58 | Unavailable |
| Sacramento-Roseville-Folsom | $59.79 | Unavailable |
| Salinas | $59.59 | Unavailable |
| San Diego-Chula Vista-Carlsbad | $61.48 | Unavailable |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $72.36 | Unavailable |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $72.34 | Unavailable |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $74.05 | Unavailable |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $73.96 | Unavailable |
| San Luis Obispo-Paso Robles | $58.56 | Unavailable |
| Santa Cruz-Watsonville | $62.45 | Unavailable |
| Santa Maria-Santa Barbara | $59.94 | Unavailable |
| Santa Rosa-Petaluma | $63.11 | Unavailable |
| Seattle (King Cnty) | $63.25 | Unavailable |
| South Carolina | $47.79 | Unavailable |
| South Dakota** | $51.33 | Unavailable |
| Southern Maine | $51.06 | Unavailable |
| Stockton | $56.37 | Unavailable |
| Suburban Chicago | $53.67 | Unavailable |
| Tennessee | $46.81 | Unavailable |
| Utah | $48.64 | Unavailable |
| Vallejo | $67.66 | Unavailable |
| Vermont | $50.93 | Unavailable |
| Virgin Islands | $52.32 | Unavailable |
| Virginia | $50.71 | Unavailable |
| Visalia | $56.37 | Unavailable |
| West Virginia | $45.36 | Unavailable |
| Wisconsin | $49.16 | Unavailable |
| Wyoming** | $51.60 | Unavailable |
| Yuba City | $56.37 | Unavailable |
95056 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$44.24
$65.21
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $54.79 | 1 |
| AL | $45.09 | 1 |
| AR | $44.24 | 1 |
| AZ | $50.09 | 1 |
| CA | $56.37–$74.05 | 29 |
| CO | $54.90 | 1 |
| CT | $55.85 | 1 |
| DC | $60.94 | 1 |
| DE | $51.09 | 1 |
| FL | $49.86–$54.89 | 3 |
| GA | $46.38–$52.72 | 2 |
| GU | $58.49 | 1 |
| HI | $58.49 | 1 |
| IA | $47.02 | 1 |
| ID | $47.33 | 1 |
| IL | $47.70–$53.67 | 4 |
| IN | $47.70 | 1 |
| KS | $46.53 | 1 |
| KY | $46.04 | 1 |
| LA | $45.87–$48.85 | 2 |
| MA | $54.34–$61.61 | 2 |
| MD | $52.33–$60.94 | 3 |
| ME | $47.43–$51.06 | 2 |
| MI | $47.41–$50.44 | 2 |
| MN | $52.78 | 1 |
| MO | $44.70–$49.32 | 3 |
| MS | $44.49 | 1 |
| MT | $51.77 | 1 |
| NC | $48.11 | 1 |
| ND | $51.37 | 1 |
| NE | $47.42 | 1 |
| NH | $53.78 | 1 |
| NJ | $56.54–$59.99 | 2 |
| NM | $47.66 | 1 |
| NV | $51.71 | 1 |
| NY | $49.02–$62.00 | 5 |
| OH | $47.33 | 1 |
| OK | $46.15 | 1 |
| OR | $51.37–$57.27 | 2 |
| PA | $47.54–$54.00 | 2 |
| PR | $52.32 | 1 |
| RI | $53.39 | 1 |
| SC | $47.79 | 1 |
| SD | $51.33 | 1 |
| TN | $46.81 | 1 |
| TX | $47.12–$54.66 | 8 |
| UT | $48.64 | 1 |
| VA | $50.71–$60.94 | 2 |
| VI | $52.32 | 1 |
| VT | $50.93 | 1 |
| WA | $54.32–$63.25 | 2 |
| WI | $49.16 | 1 |
| WV | $45.36 | 1 |
| WY | $51.60 | 1 |
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
Swap in your local Medicare rate.
Work 0.00Practice expense 1.53Malpractice 0.02
All indexes start 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
| 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
95056 vs 95052 vs 95044 vs 95004: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 95052Photopatch testing
- 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 testing
- Use 95044 for patch testing to evaluate delayed contact reactions. Use 95056 when the diagnostic test evaluates skin response to light.
- 95004Allergy skin prick 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.
Are professional and technical components billed separately?
The CMS facts supplied for 95056 do not identify separate professional and technical components. They identify the service as incident-to and require physician supervision for billing.
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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