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CPT 97028: Ultraviolet (Phototherapy) Treatment for Skin Conditions
CPT code 97028 designates phototherapy using ultraviolet radiation to treat dermatologic conditions such as dermatitis, psoriasis, actinic keratosis, and radiation-induced skin injury. Phototherapy is a common, noninvasive treatment modality in dermatology and outpatient rehabilitation settings; clarity around coding and coverage is important for consistent billing and access to care nationally. Key national payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical context for UV phototherapy, typical sites of service, commonly billed companion codes, relevant ICD-10 indications, and the list of payers addressed. The publication summarizes common modifiers and related procedural codes to aid accurate claim submission and discusses benchmarking descriptors and payer coverage patterns. It also highlights coding relationships with similar therapeutic modalities to help clinicians and billers distinguish service lines. Data not available in the input is noted where applicable; the content focuses on clarifying the clinical purpose of CPT code 97028, payer inclusion, and operational coding considerations for a national audience.
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Billing Code Overview
CPT code 97028 describes treatment using ultraviolet (UV) light therapy applied to one or more body parts to manage certain skin conditions. This service is a phototherapy procedure intended to reduce inflammation, slow abnormal cell growth, or treat lesions through controlled exposure to ultraviolet radiation.
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Service Type: Phototherapy/Ultraviolet light treatment
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Typical Site of Service: Outpatient dermatology clinics, ambulatory procedure centers, or other outpatient settings where phototherapy is delivered safely and under clinical supervision.
National Reimbursement Benchmarks
Nationally, Medicare averages $8.7 for CPT 97028 while BUCA (average commercial) sits notably higher at $20.7, indicating commercial networks pay roughly $12.0 more on average than Medicare for this service. Blue Cross Blue Shield and BUCA show the highest mean levels among payers, while Aetna, Cigna and UnitedHealth Group cluster closer to Medicare’s mean.
Looking at dispersion (P75 minus P25) to gauge variability, Blue Cross Blue Shield is the widest with a spread of $25.2, followed by BUCA at $16.0. Cigna and UnitedHealth Group show moderate spreads of $6.0 and $2.9 respectively, while Aetna is tight at $2.0. Medicare’s reported quartiles give a narrow spread of $1.0, indicating the least variability among listed payers.