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See a sample rate comparisonCPT 96571 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 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)
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Photodynamic Therapy Procedures |
| Common Place of Service | 21 - Inpatient Hospital 11 - Office |
| Common Modifiers | 59 - Distinct Procedural Service 26 - Professional component 79 - Unrelated procedure - postop period |
| Complexity Level | Low |
| Medicare Fee Schedule | $26.72 national non-facility rate (2026) · View Medicare rates for 96571 |
| Medicaid Fee Schedule | $22.41 median of the 8 states in the free preview · View Medicaid rates for 96571 |
National average reimbursement for CPT 96571 by major payers:
$38.26
$34.82
$32.15
$41.59
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CPT 96571
5 of 25 sample ratesHigher to lower in this preview
Advocate North Side Health Network, Advocate Illinois Masonic Medical Center
Advocate North Side Health Network
$6,291.00Published rateEast Georgia Regional Medical Center, LLC, East Georgia Regional Medical Center LLC
East Georgia Regional Medical Center LLC
$3,151.00Published rateEoh Acquisition Group, LLC, Carewell Health Medical Center
Eoh Acquisitions Group, LLC Dba Carewell Health
$1,424.00Published rateSt Mary Medical Center, Osf Saint Mary Medical Center
$693.00Published rateHeart Of Texas Healthcare System, Heart Of Texas Memorial Hospital
Heart Of Texas Memorial Hospital
$200.00Published rate
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See a sample payer proposalCPT 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 |
|---|---|---|
| 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 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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