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 | $363.00 | 1235387044 - HUMPHREYS COUNTY COMMUNITY HEALTH SERVICES, INC., ASCENSION SAINT THOMAS THREE RIVERS | 261861676 - (TN) HUMPHREYS COUNTY COMMUNITY HEALTH SERVICES INC | TN | Critical Access Hospital (282NC0060X) |
United | 96567 | $1459.00 | 1144251216 - PALM BEACH GARDENS COMMUNITY HOSPITAL, INC., PALM BEACH GARDENS MEDICAL CENTER | 591223933 | FL | General Acute Care Hospital (282N00000X) |
United | 96567 | $824.00 | 1205882669 - BRANDON HMA LLC, MERIT HEALTH RANKIN | 640885458 | MS | General Acute Care Hospital (282N00000X) |
United | 96567 | $550.41 | 1285295899 - AHN EMERUS WESTMORELAND LLC, AHN MCCANDLESS NEIGHBORHOOD HOSPITAL | 823697883 - (PA) AHN EMERUS WESTMORELAND LLC | PA | General Acute Care Hospital (282N00000X) |
United | 96567 | $930.00 | 1588793574 - ALHAMBRA HOSPITAL MEDICAL CENTER, LP | 954693289 - (CA) ALHAMBRA HOSPITAL MEDICAL CENTER LP | CA | General Acute Care Hospital (282N00000X) |
United | 96567 | $756.00 | 1790756203 - CLEVELAND TENNESSEE HOSPITAL COMPANY LLC, TENNOVA HEALTHCARE-CLEVELAND | 992892769 | TN | General Acute Care Hospital (282N00000X) |
United | 96567 | $506.00 | 1164510673 - PALESTINE PRINCIPAL HEALTHCARE LIMITED PARTNERSHIP, PALESTINE REGIONAL MEDICAL CENTER | 742791525 - (TX) PALESTINE PRINCIPAL HEALTHCARE LIMITED PARTNERSHIP | TX | General Acute Care Hospital (282N00000X) |
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 | $296.00 | 1487690400 - WELLMONT HEALTH SYSTEM, HOLSTON VALLEY MEDICAL CENTER | 621636465 - WELLMONT HEALTH SYSTEM | TN | General Acute Care Hospital (282N00000X) |
United | 96567 | $300.00 | 1063435782 - SOUTHWEST HEALTH CORP., HOSPITAL METROPOLITANO DE SAN GERMAN | 660558678 - (PR) SOUTHWEST HEALTH CORPORATION (HOSPI TAL SAN GERMAN, CABO ROJO, ARECIBO | PR | General Acute Care Hospital (282N00000X) |
United | 96567 | $759.00 | 1932112125 - CATHOLIC HEALTH INITIATIVES COLORADO, PENROSE HOSPITAL | 840405257 - CATHOLIC HEALTH INITIATIVES COLORADO | CO | General Acute Care Hospital (282N00000X) |
United | 96567 | $3793.00 | 1952332801 - THE NEW YORK AND PRESBYTERIAN HOSPITAL, NEW YORK-PRESBYTERIAN HOSPITAL | 133957095 - (NY) THE NEW YORK AND PRESBYTERIAN HOSPITAL | NY | General Acute Care Hospital (282N00000X) |
United | 96567 | $1299.00 | 1265092126 - UNIVERSITY OF COLORADO HOSPITAL AUTHORITY | 841179794 - (CO) UNIVERSITY OF COLORADO HOSPITAL AUTHORITY | CO | General Acute Care Hospital (282N00000X) |
United | 96567 | $1031.00 | 1619401528 - STEWARD SEBASTIAN RIVER MEDICAL CENTER, INC. | 815437273 | FL | General Acute Care Hospital (282N00000X) |
United | 96567 | $341.00 | 1306849617 - WEST ASCENSION PARISH HOSPITAL SERVICE DISTRICT, PREVOST MEMORIAL HOSPITAL | 720637478 | LA | Critical Access Hospital (282NC0060X) |
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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