CPT 97028 Ultraviolet Therapy Reimbursement | OpenPayer

Summary & Overview

CPT 97028: Ultraviolet Therapy Application in Physical Medicine

CPT code 97028 represents the application of ultraviolet therapy to one or more areas, a modality frequently used in physical medicine and rehabilitation. This procedure is primarily delivered in office settings and is integral to the management of certain dermatological and musculoskeletal conditions. Ultraviolet therapy is recognized for its clinical value in treating disorders such as psoriasis, dermatitis, and actinic keratosis, among others.

The publication covers key national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare. Readers will gain insights into payer coverage policies, relevant clinical indications, and associated billing practices for ultraviolet therapy. The analysis includes benchmarks for utilization, updates on policy changes, and context for how this service fits within broader physical medicine and rehabilitation offerings.

Additionally, the summary provides an overview of common modifiers, associated provider taxonomies, and related CPT codes, equipping stakeholders with a comprehensive understanding of the procedural, clinical, and administrative landscape for CPT code 97028. This information is essential for healthcare professionals, billing specialists, and policy analysts seeking to navigate the complexities of medical coding and reimbursement for ultraviolet therapy.

AetnaBlue Cross Blue ShieldCigna HealthMedicareUnitedHealthcareCPT 97028ultraviolet therapyphysical medicinerehabilitationoffice settingmedical billingclinical indicationsdermatologyprocedure codingpolicy updates

CPT Code Overview

CPT code 97028 is used to report the application of a modality to one or more areas, specifically ultraviolet therapy. This procedure is commonly performed as part of Physical Medicine and Rehabilitation services. The typical site of service for this code is the office setting (Place of Service 11). Ultraviolet therapy is utilized to treat various dermatological and musculoskeletal conditions, providing targeted exposure to ultraviolet light as part of a therapeutic regimen.

Clinical & Coding Specifications

Clinical Context

A patient presents to a physical medicine and rehabilitation clinic with chronic skin conditions such as psoriasis or dermatitis. The provider, typically a physical therapist or rehabilitation practitioner, evaluates the affected areas and determines that ultraviolet therapy is appropriate. The procedure involves the application of ultraviolet light to one or more areas of the skin to reduce inflammation, promote healing, or manage symptoms. The service is performed in an office setting (Place of Service 11), and may be repeated as clinically indicated. Documentation includes the indication for therapy, areas treated, duration, and response to treatment.

Coding Specifications

Modifier 59: Used to indicate a distinct procedural service, meaning the ultraviolet therapy (97028) is separate from other procedures performed on the same day.
Modifier 76: Used when the same procedure (97028) is repeated by the same provider during the same encounter or on the same day.

Modifier Code	Description

National Reimbursement Benchmarks

Medicare's national mean rate for CPT 97028 is $8.67, which is lower than the BUCA (Blue Cross Blue Shield, UnitedHealthcare, Cigna, Aetna) average commercial mean rate of $9.81. Among individual commercial payers, Blue Cross Blue Shield has the highest mean rate at $12.89, while Aetna is the lowest at $6.37.

Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. Medicare shows the tightest range at $1.00, indicating minimal variation in rates. In contrast, Cigna and Blue Cross Blue Shield exhibit the widest dispersions, with ranges of $7.00 and $5.50 respectively, reflecting greater variability in commercial reimbursement.

The table and chart below present a detailed breakdown of national mean rates and percentile values for each payer.

State Benchmarks

State: Alaska1 / 50

Alaska Benchmarks

Alaska's reimbursement rates for CPT code 97028 show a substantial spread across payers, with Blue Cross Blue Shield exhibiting the widest range between the 25th and 75th percentiles ($12.50), while UnitedHealth Group's rates are tightly clustered at $20.00 for all percentiles. Compared to national averages, Alaska's commercial payers consistently offer higher mean rates, often nearly double those seen nationwide, highlighting a premium market for this code in the state.

The table and chart below present the full breakdown of mean rates and percentile values for each payer in Alaska, allowing for direct comparison of reimbursement levels and variability across the major insurers and Medicare.

Key Insights for Alaska

Blue Cross Blue Shield is the highest paying payer for CPT 97028 in Alaska, with a mean rate of $21.23.
Medicare is the lowest paying payer, with a mean rate of $8.42, notably below the commercial payers.
All Alaska commercial payer rates are significantly higher than their respective national averages, with mean rates nearly double the national benchmarks.

97026 – Application of a modality to one or more areas; infrared

97014-APPLICATION-OF-A-MODALITY-TO-1-OR-MORE-AREAS-ELECTRICAL

97014 – Application of a modality to 1 or more areas; electrical stimulation (unattended)

97012-TRACTION-MECHANICAL-TO-ONE-OR-MORE

CPT 97012: Mechanical Traction Therapy in Physical Medicine

97034-CONTRAST-BATHS-TO-ONE-OR-MORE

CPT 97034: Contrast Bath Therapy, Constant Attendance

97010-APPLICATION-OF-A-MODALITY-TO-ONE-OR-MORE-AREAS-HOT-OR-COLD

CPT 97010: Application of Hot or Cold Packs in Physical Therapy

97036-APPLICATION-OF-A-MODALITY-TO-1-OR-MORE-AREAS-HUBBARD-TANK

CPT 97036: Hubbard Tank Hydrotherapy, Physical Medicine Modality

97018-APPLICATION-OF-A-MODALITY-TO-1-OR-MORE-AREAS-PARAFFIN