Summary & Overview
CPT 96931: Near-Infrared Skin Imaging and Interpretation
CPT code 96931 identifies a diagnostic skin imaging procedure that employs near–infrared light and computer-linked imaging to detect abnormal lesions or scar formation and to record and interpret findings for a single area of diseased or damaged tissue. This code matters nationally as advanced optical imaging increasingly informs dermatologic diagnosis, lesion surveillance, and noninvasive assessment of cutaneous pathology. Proper coding supports accurate utilization tracking and claims processing for these specialized diagnostic services.
Key payers referenced in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical intent of the code, typical sites of service, and the service type. The publication also summarizes payer coverage patterns and denials trends where available, reimbursement benchmarks, and coding guidance that affects billing and documentation. Clinical context clarifies appropriate use cases — single-lesion imaging with image capture and provider interpretation — and contrasts this service with other dermatologic imaging or procedural codes where relevant.
Data not available in the input is noted where applicable. The content is intended for national audiences seeking a clear, operational summary for coding, billing, and clinical stakeholders involved in dermatologic diagnostic imaging.
Billing Code Overview
CPT code 96931 describes a diagnostic procedure using near–infrared light directed at the skin to detect abnormal lesions or scar formation. The procedure uses a light source connected to a computer to display images of the tissue under examination. Use of this code applies when the provider saves the image, interprets the result, and reports findings for a single skin lesion or an area of damaged or diseased tissue.
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Service type: Diagnostic imaging of the skin using near–infrared optical imaging
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Typical site of service: Outpatient dermatology clinic, ambulatory surgery center, or other outpatient facility where skin imaging and image interpretation are performed
Clinical & Coding Specifications
Clinical Context
A 52-year-old patient presents to a dermatology clinic with a persistent, irregular pigmented lesion on the forearm that the referring primary care clinician flagged for further evaluation. The dermatologist performs a focused near-infrared imaging examination of the lesion using a handheld or table-mounted device connected to a computer. The provider positions the light source over the lesion, captures and saves high-resolution images of the sub-surface tissue, reviews the computer-generated display, documents findings in the medical record, and provides an interpretation and plan (for example, observation, excisional biopsy, or referral to surgical dermatology). The procedure is billed when a single lesion or a defined area of damaged or diseased tissue is imaged, the image is saved to the record, and a documented interpretation and report are completed by the provider. Typical site of service is an outpatient dermatology clinic, ambulatory surgical center, or hospital outpatient department where dermatologic diagnostic imaging is performed.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Normally used service | When the procedure is the provider’s usual and expected service during the encounter |
22 |