Reporting excimer laser therapy: When to use 96999 vs 9692x

As a result of a code descriptor change for CPT codes 96920-96922 effective Jan. 1, 2024, these codes are now to be used only for excimer laser treatment of psoriasis. This change was made by the AMA CPT to better align with the intended use of these services exclusively for psoriasis and identify the type of laser used.

At this time, benefits coverage for excimer laser therapy is mixed and if you are seeing denials for excimer laser therapy, it is important to check with your payers to determine their coverage and reimbursement policies. For example, Aetna requires that excimer laser therapy for non-psoriatic conditions (i.e., vitiligo, cutaneous T-cell lymphoma, mycosis fungoides, etc.) be billed with CPT code 96999 (Unlisted special dermatological service or procedure). However, since the CPT 96999 code has never been valued for Relative Value Units (RVUs), it leaves individual payers to assign a payment value, based on their preferred default rate. Therefore, it is advised to check your contract for payment terms, as payment may be according to the default rate specified in your agreement, which may be a percentage of billed charges.

Additionally, dermatologists need to be prepared to submit documentation to support the service (such as size of area treated). In discussions with Aetna, the AADA successfully advocated that if CPT code 96999 is being reported as similar to CPT code 96920 then notes would not be submitted and for those cases in which the treatment area is larger and the 96999 would be similar to a CPT 96921 or CPT 96922, then office notes could be submitted to support payment on par with the higher level 96921 and 96922 codes.

Documentation guidance

To support reporting of CPT codes, documentation should include the following elements:

• Size of area(s) treated

• Topical product applied

• Severity of skin condition

• Session time and strength

• Post-therapy or treatment condition

Most importantly, the clinician must customize the discussion to the condition being treated. As these unlisted codes do not represent a distinct procedure, therapy, or service, each of the code descriptors do not include defining nomenclature. When reporting unlisted codes, additional supporting documentation (e.g., procedure report) must include the following elements to convey the nature of the procedure:

• Extent of work performed

• Need for the procedure

• Time, effort, and equipment necessary to complete the service, therapy, or procedure

All of the elements needed in the supporting documentation should also be reflected in the documentation of the service or procedure and be easily inferred or identified should the medical record be requested for audit purposes.