CPT 96570 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 | • 22 - On Campus Outpatient Hospital • 21 - Inpatient Hospital |
| Common Modifiers | • None • 52 - Reduced Services • GC - Service performed by resident under supervision |
| Complexity Level | Low |
National average reimbursement for CPT 96570 by major payers:
$77.85
$73.67
$67.11
$85.72
| 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 96570 | ||||||
United | 96570 | $1411.00 | 1528028396 - SENTARA PRINCESS ANNE HOSPITAL, SENTARA HOSPITALS | 541547408 - SENTARA HOSPITALS | VA | General Acute Care Hospital (282N00000X) |
United | 96570 | $1438.00 | 1013994359 - FAIRVIEW HEALTH SERVICES, UNIVERSITY OF MN MEDICAL CENTER, FAIRVIEW | 410991680 - FAIRVIEW HEALTH SERVICES | MN | General Acute Care Hospital (282N00000X) |
United | 96570 | $5935.00 | 1811992480 - PASCACK VALLEY HOSPITAL | 264051248 | NJ | General Acute Care Hospital (282N00000X) |
United | 96570 | $1954.00 | 1437107208 - CASA GRANDE COMMUNITY HOSPITAL, CASA GRANDE REGIONAL MEDICAL CENTER | 450233470 - BANNER HEALTH | AZ | General Acute Care Hospital (282N00000X) |
United | 96570 | $551.00 | 1356320873 - EAST TEXAS MEDICAL CENTER ATHENS | 823934511 | TX | General Acute Care Hospital (282N00000X) |
United | 96570 | $433.00 | 1265445506 - WILLIAMSON COUNTY HOSPITAL DISTRICT, WILLIAMSON MEDICAL CENTER | 621501534 | TN | General Acute Care Hospital (282N00000X) |
United | 96570 | $1969.00 | 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 | 96570 | $1988.00 | 1891367629 - STEWARD NSMC, INC., STEWARD FLORIDA MEDICAL CENTER A CAMPUS OF NORTH SHORE | 995054044 | FL | General Acute Care Hospital (282N00000X) |
United | 96570 | $428.00 | 1225081516 - GADSDEN REGIONAL MEDICAL CENTER LLC, GADSDEN REGIONAL MEDICAL CENTER | 631102774 | AL | General Acute Care Hospital (282N00000X) |
United | 96570 | $100.00 | 1437179710 - PEMISCOT COUNTY MEMORIAL HOSPITAL | 436004544 - (MO) PEMISCOT COUNTY MEMORIAL HOSPITAL | MO | General Acute Care Hospital (282N00000X) |
United | 96570 | $801.00 | 1639101116 - SIERRA VISTA HOSPITAL, INC., SIERRA VISTA REGIONAL MEDICAL CENTER | 952588614 | CA | General Acute Care Hospital (282N00000X) |
United | 96570 | $752.00 | 1497702575 - ORANGE COAST MEMORIAL MEDICAL CENTER | 330687414 - (CA) MEMORIAL HEALTH SERVICES | CA | General Acute Care Hospital (282N00000X) |
United | 96570 | $743.00 | 1164821559 - NATCHEZ HOSPITAL COMPANY LLC, MERIT HEALTH NATCHEZ | 371756496 | MS | General Acute Care Hospital (282N00000X) |
United | 96570 | $464.00 | 1649226952 - ANDERSON REGIONAL MEDICAL CENTER, ANDERSON REGIONAL MEDICAL CENTER | 640362400 - (MS) ANDERSON REGIONAL MEDICAL CENTER | MS | General Acute Care Hospital (282N00000X) |
United | 96570 | $2076.00 | 1700883717 - RIVERVIEW HOSPITAL | 351128943 - RIVERVIEW HOSPITAL | IN | 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 96570 vs. Other Photodynamic Therapy Procedures Codes
The CPT 96570 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 96570 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 96570. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96570 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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