CPT 96931
Global XXX ActiveRcm img acquisj&i&r 1st les
CPT 96931 Billing & Documentation Guide
CPT code 96931 (Rcm img acquisj&i&r 1st les) is classified under Dermatology with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.78, a non-facility practice expense RVU of 4.11, and a malpractice RVU of 0.04, a total non-facility RVU of 4.93 and facility RVU of 4.93. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $171, though rates vary from $144.66 to $227.59 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 96931, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 96931 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
No global period (E/M and other non-procedural services)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 96931 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 96931
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.78 | 0.78 |
| Practice Expense RVU | 4.11 | 4.11 |
| Malpractice RVU | 0.04 | 0.04 |
| Total RVU | 4.93 | 4.93 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 96931
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $190.15 | $190.15 | $177.67 - $227.59 | 29 |
| Florida | $166.39 | $166.39 | $159.3 - $172.34 | 3 |
| Georgia | $158.66 | $158.66 | $150.1 - $167.21 | 2 |
| Illinois | $161.35 | $161.35 | $153.48 - $169.59 | 4 |
| Michigan | $156.84 | $156.84 | $152.9 - $160.78 | 2 |
| North Carolina | $154.99 | $154.99 | $154.99 - $154.99 | 1 |
| New York | $182.25 | $182.25 | $157.41 - $193.42 | 5 |
| Ohio | $152.73 | $152.73 | $152.73 - $152.73 | 1 |
| Pennsylvania | $162.18 | $162.18 | $153.34 - $171.02 | 2 |
| Texas | $162.59 | $162.59 | $152.22 - $172.53 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 96931
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 96931 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0400T | Column 1 (primary), can be billed with modifier | Yes | Mutually exclusive procedures |
| 0401T | Column 1 (primary), can be billed with modifier | Yes | Mutually exclusive procedures |
| 0470T | Column 1 (primary), can be billed with modifier | Yes | Mutually exclusive procedures |
| 0471T | Column 1 (primary), can be billed with modifier | Yes | Mutually exclusive procedures |
| 76000 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 76001 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 76942 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 76970 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 76998 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 96523 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
Frequently Asked Questions, CPT 96931
What does CPT code 96931 mean? +
CPT code 96931 represents: Rcm img acquisj&i&r 1st les. It's in the Dermatology category with a global period of XXX.
What is the Medicare reimbursement for CPT 96931? +
The 2026 Medicare national average non-facility payment for CPT 96931 is $171. Rates range from $144.66 to $227.59 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 96931? +
Medicine section spans a wide range: therapy services use GP/GO/GN (PT/OT/SLP plans of care) and KX (above cap with documentation). Drug administration uses JW (waste) and JZ (no waste). Professional/technical split applies to some diagnostic codes.
What bundling edits apply to CPT 96931? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 1, 2026.
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