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See a sample rate comparisonCPT 96567 Fee Schedule
Last Verified: October 2026
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.
Photodynamic Therapy By Extern, Photodynamic Therapy By External Application Of Light To Destroy Premalignant Lesions Of The Skin And Adjacent Mucosa With Application And Illuminationactivation Of Photosensitive Drug(S) Per Day
| 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 | PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | $129.26 national non-facility rate (2026) · View Medicare rates for 96567 |
| Medicaid Fee Schedule | $111.56 median of the 8 states in the free preview · View Medicaid rates for 96567 |
National average reimbursement for CPT 96567 by major payers:
$171.99
$161.63
$174.17
$213.10
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CPT 96567
5 of 25 sample ratesHigher to lower in this preview
The New York And Presbyterian Hospital, New York-Presbyterian Hospital
The New York And Presbyterian Hospital
$3,793.00Published ratePalm Beach Gardens Community Hospital, Inc., Palm Beach Gardens Medical Center
$1,459.00Published rateBrandon Hma LLC, Merit Health Rankin
$824.00Published ratePalestine Principal Healthcare Limited Partnership, Palestine Regional Medical Center
Palestine Principal Healthcare Limited Partnership
$506.00Published rateAspen Mountain Medical Center LLC
$293.00Published rate
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See a sample payer proposalCPT 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 Extern, Photodynamic Therapy By External Application Of Light To Destroy Premalignant Lesions Of The Skin And Adjacent Mucosa With Application And Illuminationactivation Of Photosensitive Drug(S) Per Day |
| 96570-CPT | Low | Photodynmc Tx 30 Min Add-On, 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 Tx Addl 15 Min, 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 Extern, Photodynamic Therapy By External Application Of Light To Destroy Premalignant Lesions Of The Skin And Adjacent Mucosa With Application And Illuminationactivation Of Photosensitizing Drug(S) Provided By A Physician Or Other Qualified Health 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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