CPT 96571 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 | • 21 - Inpatient Hospital • 11 - Office |
| Common Modifiers | • None • 59 - Distinct Procedural Service • 26 - Professional component • 79 - Unrelated procedure - postop period |
| Complexity Level | Low |
National average reimbursement for CPT 96571 by major payers:
$38.26
$34.82
$32.15
$41.77
| 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 96571 | ||||||
United | 96571 | $3990.00 | 1619938016 - DANBURY HOSPITAL, DANBURY HOSPITAL DBA NEW MILFORD HOSPITAL | 60646597 - DANBURY HOSPITAL | CT | General Acute Care Hospital (282N00000X) |
United | 96571 | $2507.00 | 1174530349 - LONG ISLAND JEWISH MEDICAL CENTER, STEVEN & ALEXANDRA COHEN CHILDREN'S MEDICAL CENTER OF NEW YORK | 112241326 - LONG ISLAND JEWISH MEDICAL CENTER | NY | Children's Hospital (282NC2000X) |
United | 96571 | $1598.00 | 1295718450 - CENTRASTATE MEDICAL CENTER, INC | 221750190 - (NJ) CENTRASTATE MEDICAL CENTER INC | NJ | General Acute Care Hospital (282N00000X) |
United | 96571 | $766.00 | 1144225699 - WALKER COUNTY HOSPITAL CORPORATION, HUNTSVILLE MEMORIAL HOSPITAL | 843654542 - (TX) HUNTSVILLE COMMUNITY HOSPITAL INC | TX | General Acute Care Hospital (282N00000X) |
United | 96571 | $1623.00 | 1679659585 - PRESENCE CHICAGO HOSPITALS NETWORK, PRESENCE SAINT JOSEPH HOSPITAL-CHICAGO | 362235165 - (IL) PRESENCE CHICAGO HOSPITALS NETWORK | IL | General Acute Care Hospital (282N00000X) |
United | 96571 | $672.00 | 1427064310 - MARY IMMACULATE HOSPITAL LLC, MARY IMMACULATE HOSPITAL | 540548200 | VA | General Acute Care Hospital (282N00000X) |
United | 96571 | $1665.00 | 1174977557 - BBH CBMC, LLC, CITIZENS BAPTIST MEDICAL CENTER | 474802869 | AL | General Acute Care Hospital (282N00000X) |
United | 96571 | $1424.00 | 1013386143 - EOH ACQUISITION GROUP, LLC, CAREWELL HEALTH MEDICAL CENTER | 854153331 - (NJ) EOH ACQUISITIONS GROUP, LLC DBA CAREWELL HEALTH | NJ | General Acute Care Hospital (282N00000X) |
United | 96571 | $2475.00 | 1891808499 - HOUSTON HOSPITALS INC, PERRY HOSPITAL | 711045290 - (GA) HOUSTON HOSPITALS INC | GA | General Acute Care Hospital (282N00000X) |
United | 96571 | $1534.00 | 1043526023 - WARREN OHIO HOSPITAL COMPANY LLC, TRUMBULL MEMORIAL HOSPITAL | 815457243 | OH | General Acute Care Hospital (282N00000X) |
United | 96571 | $187.00 | 1447377767 - HOSPITAL SERVICE DISTRICT NO. 1 OF THE PARISH OF VERMILION, ABROM KAPLAN MEMORIAL HOSPITAL | 472540179 - (LA) KAPLAN GENERAL HOSPITAL INC | LA | Critical Access Hospital (282NC0060X) |
United | 96571 | $3339.00 | 1750722351 - PALISADES MEDICAL CENTER | 221487576 - HACKENSACK MERIDIAN HEALTH INC | NJ | General Acute Care Hospital (282N00000X) |
United | 96571 | $1201.00 | 1013382860 - LARKIN COMMUNITY HOSPITAL PALM SPRINGS CAMPUS, LLC | 475625607 | FL | General Acute Care Hospital (282N00000X) |
United | 96571 | $1954.00 | 1184691610 - CAPE CANAVERAL HOSPITAL, INC. | 592477479 - (FL) CAPE CANAVERAL HOSPITAL INC | FL | General Acute Care Hospital (282N00000X) |
United | 96571 | $575.00 | 1487253449 - VANDERBILT BEDFORD HOSPITAL, LLC, VANDERBILT BEDFORD HOSPITAL | 853419620 | TN | 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 96571 vs. Other Photodynamic Therapy Procedures Codes
The CPT 96571 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 96571 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 |
|---|---|---|
| 96523-CPT | Low | Irrigation Of Implanted Venous Access Device For Drug Delivery Systems |
| 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) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 96571. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96571 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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