Ultraviolet therapy
CPT code 97028 covers ultraviolet light therapy, a treatment where controlled UV light is applied to the skin to treat conditions like psoriasis, eczema, and vitiligo. This is typically done using specialized lamps in a medical office setting.
RVU breakdown
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
Billing tips
Bill only for time when patient is actually under the UV light, not preparation or post-treatment observation time
Impact: Prevents upcoding accusations and reduces audit risk; each session should reflect actual treatment duration typically 5-20 minutes
Document skin type classification (Fitzpatrick scale), initial minimal erythema dose (MED), and incremental dosing adjustments with each session
Impact: Essential for medical necessity; missing MED documentation causes approximately 30-40% of denials for this code
Verify LCD/NCD requirements for your MAC region regarding frequency limitations, typically 2-3 times weekly maximum for most diagnoses
Impact: Daily billing often triggers automatic denials; following MAC-specific frequency guidelines prevents $8.09 payment losses per rejected session
Append modifier GP when billing under a physical therapy plan to ensure proper therapy cap application and tracking
Impact: Missing GP modifier can result in incorrect benefit categorization and unexpected denials once therapy threshold is reached
Always link to specific ICD-10 codes demonstrating photoresponsive conditions (L40.x for psoriasis, L20.x for dermatitis) rather than general skin condition codes
Impact: Non-specific diagnosis codes account for 25% of 97028 denials; specific codes improve first-pass payment rate
When billing with E/M services on same day, ensure separate documentation establishes UV therapy as distinct from evaluation, or append modifier 25 to E/M code
Impact: Prevents E/M bundling denial; maintains full payment for both services when appropriately documented
Common denials
Frequency limitations exceeded - billing more than 2-3 times per week without exceptional medical necessity documentation
How to appeal: Submit clinical notes demonstrating severe disease state, prior authorization if obtained, peer-reviewed literature supporting intensive protocol, and photographic evidence of treatment response. Request MAC-specific coverage guidelines and cite compliance.
Missing or inadequate documentation of MED testing and dose calculations for patient's skin type
How to appeal: Provide complete treatment logs showing initial MED determination, Fitzpatrick skin type classification, UV dosimetry records, and progressive dose adjustment rationale. Include equipment calibration records if available.
Medical necessity not established - lack of documentation showing failure of conservative treatments before phototherapy initiation
How to appeal: Submit records demonstrating trial of topical therapies, timeline of treatment progression, physician notes justifying phototherapy as appropriate next step, and clinical photographs showing extent/severity of condition.
Bundling with other physical medicine procedures performed same day without appropriate modifier
How to appeal: Resubmit claim with modifier 59 attached to 97028, provide documentation showing UV therapy as distinct service with separate therapeutic purpose, different body area, or separate session time from other billed procedures.
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 is based on 0.25 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by locality based on geographic practice cost indices (GPCI).
How many times per week can you bill CPT 97028 for ultraviolet therapy?
Most Medicare Administrative Contractors (MACs) allow 2-3 times per week for ultraviolet therapy under standard protocols. Daily or more frequent billing typically requires exceptional documentation of medical necessity and may trigger prior authorization requirements. Always verify your specific MAC's Local Coverage Determination (LCD) for frequency limitations.
What diagnosis codes support medical necessity for CPT 97028?
Common supporting diagnoses include psoriasis (L40.x series), atopic dermatitis (L20.x), vitiligo (L80), mycosis fungoides (C84.0x), polymorphous light eruption (L56.4), and other photoresponsive dermatoses. The diagnosis must demonstrate a condition proven responsive to UV therapy and typically requires documentation of failed conservative treatments first.
Can CPT 97028 be billed with an office visit on the same day?
Yes, but the E/M service must be separately identifiable and significant. Append modifier 25 to the E/M code if billing both services. The office visit should address issues beyond the routine delivery of UV therapy. If the visit is solely to administer the UV treatment without separate evaluation, only 97028 should be billed.
What documentation is required to bill CPT 97028 without denials?
Essential documentation includes patient skin type (Fitzpatrick scale), initial MED testing results, specific UV wavelength used, dose delivered in joules/cm², treatment duration, body areas treated, clinical response, and ongoing medical necessity. Equipment calibration records and progressive dose adjustments should also be maintained for audit purposes.
Does CPT 97028 require direct physician supervision or can PTs bill independently?
CPT 97028 requires physician supervision, but the level varies by payer and setting. Physical therapists may administer and bill UV therapy under general physician supervision in most states. However, initial MED determination and treatment protocol establishment typically require direct physician involvement. Verify state scope of practice laws and payer-specific supervision requirements.
What is the difference between CPT 97028 and 96900 for UV therapy?
CPT 97028 is used for physical medicine/therapy-based UV light application and pays $8.09. CPT 96900 (actinotherapy) is essentially obsolete and rarely used. For PUVA therapy (psoralen plus UVA), use 96912-96913. Code selection depends on whether oral/topical photosensitizers are used and whether the service is provided as dermatologic treatment versus physical therapy modality.