2025 CPT code 96934
(Active) Effective Date: N/A Medicine - Special Dermatological Procedures Medicine Feed
Reflectance confocal microscopy (RCM) for cellular and subcellular imaging of skin; image acquisition and interpretation and report, each additional lesion.
Modifiers may be applicable to 96934 in certain circumstances. For example, modifier 59 may be used to indicate a distinct procedural service if RCM is performed on additional lesions that are not contiguous with the primary lesion and require separate preparation and imaging.
Medical necessity for 96934 must be supported by the clinical condition being evaluated.The additional lesions examined must require the detailed cellular and subcellular imaging provided by RCM to aid in diagnosis or treatment planning.Documentation must justify why these additional lesions require RCM beyond visual inspection or other less intensive methods.
The physician examines additional skin lesions using reflectance confocal microscopy (RCM) during the same session as the primary RCM examination (96931). This involves focusing near-infrared light onto the skin lesion and capturing the reflected light to create detailed images of the cellular and subcellular structures. The physician then interprets these images and prepares a report detailing the findings for each additional lesion.
In simple words: This procedure uses a special microscope and infrared light to examine additional skin lesions in detail. The doctor takes pictures of the skin's layers, analyzes them, and provides a report for each additional lesion examined. This helps in detecting abnormalities or scar formation.
This procedure involves using reflectance confocal microscopy (RCM) to obtain cellular and subcellular images of additional skin lesions. It includes image acquisition, interpretation, and a report of the findings for each lesion beyond the first one examined with RCM.The physician uses a device emitting near-infrared light, which is focused on the skin.This light reflects back differently based on the skin's structure, allowing visualization of cellular and subcellular details. The device is connected to a computer that displays the images, which are then interpreted and reported.
Example 1: A patient presents with multiple suspicious moles. The physician performs RCM on the first mole (96931) and then uses 96934 for each additional mole examined with RCM during the same encounter., A patient with a history of skin cancer has several areas of concern identified during a skin check. The physician performs RCM on the most concerning lesion (96931) and then uses 96934 to examine two additional suspicious lesions with RCM., A patient presents with a rash with several distinct areas of involvement. To determine the nature of the rash, the physician performs RCM on one area (96931) and then examines two additional affected areas using 96934.
Documentation should include detailed information about the location and characteristics of each lesion examined, the number of lesions examined with RCM, the images obtained, and the physician's interpretation of the findings.A clear statement of medical necessity supporting the use of RCM for each additional lesion is also required.
** It is crucial to differentiate this code (96934) from other RCM codes like 96935 (image acquisition only) and 96936 (interpretation and report only). Code 96934 encompasses all three components—image acquisition, interpretation, and report—for each additional skin lesion examined by RCM.Always check with specific payer guidelines for coverage and reimbursement policies.
- Specialties:Dermatology, Mohs Surgery, potentially other specialties managing skin conditions
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center