CPT 96567 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Medicine Services and Procedures • Photodynamic Therapy Procedures |
| Common Place of Service | • 11 - Office • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments • 59 - Distinct Procedural Service |
| Complexity Level | Low |
National average reimbursement for CPT 96567 by major payers:
$171.99
$161.63
$174.17
$213.83
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 96567 | ||||||
United | 96567 | $293.00 | 1811376478 - ASPEN MOUNTAIN MEDICAL CENTER LLC | 462887963 - (WY) ASPEN MOUNTAIN MEDICAL CENTER LLC | WY | General Acute Care Hospital (282N00000X) |
United | 96567 | $4985.00 | 1174579155 - NORTH FLORIDA REGIONAL MEDICAL CENTER, INC., HCA FLORIDA NORTH FLORIDA HOSPITAL | 611269294 | FL | General Acute Care Hospital (282N00000X) |
United | 96567 | $1538.00 | 1053447086 - JANE PHILLIPS NOWATA HEALTH CENTER | 731440267 - (OK) JANE PHILLIPS NOWATA HEALTH CENTER | OK | Critical Access Hospital (282NC0060X) |
United | 96567 | $1475.00 | 1740450121 - HOUSTON NORTHWEST OPERATING COMPANY, LLC, HOUSTON NORTHWEST MEDICAL CENTER ACUTE | 261512163 | TX | General Acute Care Hospital (282N00000X) |
United | 96567 | $1607.00 | 1821720681 - PARKVIEW MEDICAL CENTER, INC., PARKVIEW PUEBLO WEST | 840935136 - (CO) PARKVIEW MEDICAL CENTER INC | CO | General Acute Care Hospital (282N00000X) |
United | 96567 | $380.00 | 1124369137 - UVA PRINCE WILLIAM MEDICAL CENTER, UVA HEALTH HAYMARKET MEDICAL CENTER | 540696355 - (VA) UVA PRINCE WILLIAM MEDICAL CENTER | VA | General Acute Care Hospital (282N00000X) |
United | 96567 | $30.45 | 1013908912 - INDEPENDENT IMAGING, LLC | 651090586 - (FL) INDEPENDENT IMAGING, L.L.C. | FL | Radiology Clinic/Center (261QR0200X) |
United | 96567 | $1389.00 | 1669631792 - ST JOHN SAPULPA, INC | 730662663 - (OK) ST JOHN SAPULPA INC | OK | Critical Access Hospital (282NC0060X) |
United | 96567 | $1772.00 | 1649273434 - BAYLOR REGIONAL MEDICAL CENTER AT PLANO, BAYLOR SCOTT & WHITE MEDICAL CENTER - PLANO | 820551704 - (TX) BAYLOR REGIONAL MEDICAL CENTER AT PLANO | TX | General Acute Care Hospital (282N00000X) |
United | 96567 | $2000.00 | 1518911833 - COLUMBIA NORTH HILLS HOSPITAL SUBSIDIARY LP, MEDICAL CITY NORTH HILLS | 621682205 - (TX) COLUMBIA NORTH HILLS HOSPITAL SUBSIDIARY LP | TX | General Acute Care Hospital (282N00000X) |
United | 96567 | $1215.00 | 1992159289 - THEDACARE MEDICAL CENTER, COMMUNITY HEALTH NETWORK, INC. AND BERLIN MEMORIAL HOSPITAL | 390806359 - (WI) THEDACARE MEDICAL CENTER-BERLIN INC | WI | Critical Access Hospital (282NC0060X) |
United | 96567 | $836.00 | 1104856095 - DESERT REGIONAL MEDICAL CENTER, INC., DESERT REGIONAL MEDICAL CENTER | 752694137 | CA | General Acute Care Hospital (282N00000X) |
United | 96567 | $566.00 | 1316902414 - MERCY HOSPITAL ROGERS, MERCY HOSPITAL NORTHWEST ARKANSAS | 710294390 - MERCY HOSPITAL ROGERS | AR | General Acute Care Hospital (282N00000X) |
United | 96567 | $3032.00 | 1013998426 - WSNCHS NORTH, INC., ST. JOSEPH HOSPITAL | 113438973 - ST JOSEPH HOSPITAL | NY | General Acute Care Hospital (282N00000X) |
United | 96567 | $906.96 | 1548716665 - UPSTATE AFFILIATE ORGANIZATION, GHS CANCER INST-ANDREWS | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 96567 vs. Other Photodynamic Therapy Procedures Codes
The CPT 96567 code is part of the Medicine Services and Procedures services used for Photodynamic Therapy Procedures. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 96567 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 96567-CPT | Low | Photodynamic Therapy By External Application Of Light To Destroy Premalignant Lesions Of The Skin And Adjacent Mucosa With Application And Illumination/Activation Of Photosensitive Drug(S) Per Day (Desc Revised 1/1/2018) |
| 96570-CPT | Low | Photodynamic Therapy By Endoscopic Application Of Light To Ablate Abnormal Tissue Via Activation Of Photosensitive Drug(S); First 30 Minutes (List Separately In Addition To Code For Endoscopy Or Bronchoscopy Procedures Of Lung And Gastrointestinal Tract) |
| 96571-CPT | Low | Photodynamic Therapy By Endoscopic Application Of Light To Ablate Abnormal Tissue Via Activation Of Photosensitive Drug(S); Each Additional 15 Minutes (List Separately In Addition To Code For Endoscopy Or Bronchoscopy Procedures Of Lung And Gastrointestinal Tract) |
| 96573-CPT | Moderate | Photodynamic Therapy By External Application Of Light To Destroy Premalignant Lesions Of The Skin And Adjacent Mucosa With Application And Illumination/Activation Of Photosensitizing Drug(S) Provided By A Physician Or Other Qualifiedhealth Care Professional Per Day |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 96567. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96567 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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