2025 CPT code 96999
(Active) Effective Date: N/A Medicine Services and Procedures - Special Dermatological Procedures Medicine Feed
Unlisted special dermatological service or procedure.
Modifiers can be applicable. Modifier 22 (Increased Procedural Services) may be appropriate if the procedure is significantly more complex than usual. Modifier 25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service) may be used if applicable.
Medical necessity must be clearly established for any procedure billed under 96999.The documentation should support why the procedure was medically necessary and why no other CPT code accurately captures the service.
The dermatologist or other qualified healthcare professional is responsible for performing and documenting the unlisted procedure. Clear documentation including a detailed description of the procedure, its purpose, and the medical necessity should be provided. It's helpful to compare the procedure to similar existing CPT codes and explain why those codes are not applicable.
In simple words: This code is used when a dermatologist performs a skin-related procedure that doesn't have its own specific code.It's important for the doctor to document exactly what procedure was done so that insurance understands the service provided.
This code is used for any special dermatological service or procedure that is not described by a specific CPT code.It acts as a placeholder for unusual or unique dermatological procedures. Because of its non-specific nature, detailed documentation is crucial when billing to ensure proper reimbursement.
Example 1: A patient presents with a rare skin lesion that requires a novel laser treatment not described by any existing CPT code. The dermatologist documents the details of the laser treatment, its medical necessity, and why other laser treatment codes are not applicable, then bills using 96999., A dermatologist develops a new technique for skin biopsy involving specialized instrumentation. As this technique is not described by a specific CPT code, the dermatologist uses 96999 and provides detailed documentation., A patient undergoes a complex dermatological procedure that involves multiple steps and combines elements of several different procedures, none of which accurately encompass the totality of the service provided. The dermatologist carefully documents all aspects of the procedure and uses 96999.
When using 96999, extremely detailed documentation is essential. The documentation should include a complete description of the procedure performed, the medical necessity, the instrumentation used, the time spent, the complexity of the procedure, and a comparison to similar procedures with existing CPT codes, explaining why those codes are not applicable. Operative notes and any relevant supporting documentation should also be included.
** Carriers determine reimbursement for 96999 on a case-by-case basis, relying heavily on the documentation provided. Contacting the specific payer for pre-authorization and providing them with all the documentation before performing the procedure can help avoid claim denial.
- Payment Status: Active
- Specialties:Dermatology
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center, other places of service may be appropriate depending on where the procedure is performed.