CPT 97028: Ultraviolet Phototherapy for Skin Conditions
Medicare pays $9 and commercial payers pay $21 on average nationally for this procedure.
CPT code 97028 describes application of ultraviolet (UV) radiation to one or more body areas for treatment of certain skin conditions; this is a therapeutic phototherapy service typically provided in outpatient clinic or dermatology office settings and classified as a physical modality treatment for dermatologic indications.
For related coverage guidance, see recent payer policy updates: Hip Arthroplasty (partial and total hip replacement), Shoulder Arthroplasty (Total, Partial, Reverse, Revision and Resurfacing), Artificial Lumbar Intervertebral Disc (Lumbar Total Disc Arthroplasty).
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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.