CPT 97028Physical Therapy

Ultraviolet therapy

CPT code 97028 covers ultraviolet (UV) light therapy treatments used to treat skin conditions like psoriasis, eczema, and vitiligo. This is a therapeutic service typically performed in a medical office or clinic setting.

Showing rates for

National Average

Base Medicare rate

$8.09

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

0.08

PE RVU (NF)

0.16

MP RVU

0.01

Total RVU

0.25

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Bill 97028 only once per session regardless of treatment duration or number of body areas exposed
Impact: Prevents automatic denials; 97028 is per-session billing, not time-based or per-area. Duplicate billing reduces reimbursement by 100% on rejected claims
Document the specific UV wavelength used (UVA, UVB, narrowband UVB, PUVA) and the joules or dosage delivered
Impact: Supports medical necessity during audits; missing dosage documentation is cited in 35-40% of phototherapy claim denials
Link 97028 to appropriate ICD-10 diagnosis codes such as L40.0 (psoriasis vulgaris) or L20.9 (atopic dermatitis) that support medical necessity
Impact: Improper diagnosis code matching causes 20-25% denial rate; correct linkage ensures first-pass acceptance
Do not bill 97028 on the same date as evaluation/management services unless modifier 25 is appended to the E/M with distinct documentation
Impact: Bundling edits may reduce E/M payment; proper use of modifier 25 preserves full E/M reimbursement (typically $75-$200 depending on level)
Track and document cumulative UV exposure over the treatment course to support ongoing medical necessity
Impact: Payers may deny after 20-30 sessions without documented clinical progress notes; proper tracking maintains reimbursement throughout treatment series
Verify that your practice's UV equipment is FDA-cleared and properly maintained with calibration logs
Impact: Equipment compliance issues can trigger retrospective denials; maintaining calibration records prevents recoupment of past payments

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 97028 in 2025?

The 2025 Medicare national average payment rate for CPT 97028 is $8.09 for both facility and non-facility settings. This rate is based on a total RVU of 0.25 multiplied by the 2025 conversion factor of 32.3465. Actual reimbursement may vary by geographic location based on local wage index adjustments.

How many times can you bill CPT 97028 per day?

CPT 97028 should typically be billed only once per day as it represents one ultraviolet therapy session regardless of duration or areas treated. Billing multiple units in one day requires exceptional circumstances with clear documentation of medical necessity for separate distinct sessions and may require modifier 76 to indicate a repeat procedure by the same provider.

Can CPT 97028 be billed with an office visit on the same day?

Yes, CPT 97028 can be billed with an evaluation and management (E/M) service on the same day if the E/M represents a significant, separately identifiable service beyond the routine assessment for UV therapy. Append modifier 25 to the E/M code and ensure documentation clearly distinguishes the separate E/M service from the therapy procedure.

What diagnosis codes support medical necessity for CPT 97028?

Common ICD-10 codes supporting CPT 97028 include L40.0 (psoriasis vulgaris), L40.4 (guttate psoriasis), L20.9 (atopic dermatitis), L80 (vitiligo), L41.1 (pityriasis lichenoides chronica), and C84.0 (mycosis fungoides). Documentation should show that conservative topical treatments were tried first and the severity justifies phototherapy intervention.

Is CPT 97028 covered by Medicare and commercial insurance?

Yes, Medicare covers CPT 97028 when medically necessary for conditions like psoriasis, eczema, and vitiligo, typically after failure of topical treatments. Commercial insurance coverage varies by payer and plan; many require prior authorization and have specific coverage policies limiting treatment frequency or total number of sessions. Always verify coverage and obtain prior authorization when required.

What is the RVU value for CPT code 97028 in 2025?

CPT 97028 has a total RVU of 0.25 for 2025, consisting of 0.08 work RVU, 0.16 practice expense RVU (both facility and non-facility), and 0.01 malpractice RVU. This relatively low RVU reflects the brief service time and minimal physician work involved in administering ultraviolet therapy.

How should UV therapy be documented for billing CPT 97028?

Documentation must include the physician treatment plan, specific UV modality used (UVA, UVB, narrowband UVB), exact dosage in joules/cm² or exposure time, body areas treated, patient skin type, session number in treatment series, clinical response to date, and any adverse reactions. Missing dosage documentation is a common reason for claim denials and audit findings.