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 | $927.00 | 1265833487 - VANDERBILT UNIVERSITY MEDICAL CENTER | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | General Acute Care Hospital (282N00000X) |
United | 96570 | $438.00 | 1063441293 - EMANATE HEALTH MEDICAL CENTER, CITRUS VALLEY MEDICAL CENTER INC. | 956006469 - (CA) EMANATE HEALTH MEDICAL CENTER | CA | General Acute Care Hospital (282N00000X) |
United | 96570 | $496.00 | 1346248663 - MARTHA JEFFERSON HOSPITAL | 540261840 - (VA) MARTHA JEFFERSON HOSPITAL | VA | General Acute Care Hospital (282N00000X) |
United | 96570 | $1772.00 | 1992700983 - BAYLOR MEDICAL CENTER AT IRVING, BAYLOR SCOTT & WHITE MEDICAL CENTER - IRVING | 752586857 - (TX) BAYLOR MEDICAL CENTER AT IRVING | TX | General Acute Care Hospital (282N00000X) |
United | 96570 | $1772.00 | 1962504340 - TEXAS HEART HOSPITAL OF THE SOUTHWEST LLP, BAYLOR SCOTT & WHITE THE HEART HOSPITAL - PLANO | 412101361 - (TX) TEXAS HEART HOSPITAL OF THE SOUTHWEST, L.L.P | TX | General Acute Care Hospital (282N00000X) |
United | 96570 | $1670.00 | 1811341167 - BBH SBMC, LLC, SHELBY BAPTIST MEDICAL CENTER | 474780023 | AL | General Acute Care Hospital (282N00000X) |
United | 96570 | $551.00 | 1295036770 - CRESCENT CITY SURGICAL CENTRE OPERATING COMPANY, L.L.C. | 270508997 - (LA) CRESCENT CITY SURGICAL CENTRE OPERATING COMPANY LLC | LA | General Acute Care Hospital (282N00000X) |
United | 96570 | $35.13 | 1275906927 - PREMIERE IMAGING AND OPEN MRI INC, PREMIERE IMAGING AND OPEN MRI INC | 472034029 - (IL) PREMIERE IMAGING AND OPEN MRI INC | IL | Radiology Clinic/Center (261QR0200X) |
United | 96570 | $814.00 | 1255684460 - INOVA HEALTH CARE SERVICES, INOVA ALEXANDRIA HOSPITAL | 540620889 - INOVA HEALTH CARE SERVICES | VA | General Acute Care Hospital (282N00000X) |
United | 96570 | $1789.00 | 1265740195 - AURORA MEDICAL CENTER GRAFTON, LLC | 272953799 - AURORA HEALTH CARE INC | WI | General Acute Care Hospital (282N00000X) |
United | 96570 | $738.00 | 1649355702 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | General Acute Care Hospital (282N00000X) |
United | 96570 | $815.00 | 1649381682 - O'CONNOR HOSPITAL | 946000533 | CA | 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 | $631.00 | 1497804249 - PENN PRESBYTERIAN MEDICAL CENTER | 232810852 - PRESBYTERIAN MEDICAL CENTER OF THE UNIVERSITY OF PENNSYLVANIA HEALTH | PA | General Acute Care Hospital (282N00000X) |
United | 96570 | $854.00 | 1407962046 - DLP HARRIS REGIONAL HOSPITAL LLC, HARRIS REGIONAL HOSPITAL | 383932775 | NC | 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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