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 | $3319.00 | 1700910189 - DIGNITY COMMUNITY CARE, CHANDLER REGIONAL MEDICAL CENTER | 951642380 | AZ | General Acute Care Hospital (282N00000X) |
United | 96571 | $632.00 | 1366465866 - LONGMONT UNITED HOSPITAL, LONGMONT UNITED HOSPITAL | 840460697 - LONGMONT UNITED HOSPITAL | CO | General Acute Care Hospital (282N00000X) |
United | 96571 | $5437.00 | 1548375082 - ADVOCATE HEALTH AND HOSPITALS CORPORATION, ADVOCATE CHRIST MEDICAL CENTER | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | General Acute Care Hospital (282N00000X) |
United | 96571 | $2256.00 | 1285798918 - UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER AT DALLAS, UT SOUTHWESTERN UNIVERSITY HOSPITAL | 753175630 | TX | General Acute Care Hospital (282N00000X) |
United | 96571 | $2000.00 | 1134172406 - COLUMBIA MEDICAL CENTER OF ARLINGTON SUBSIDIARY LP, MEDICAL CITY ARLINGTON | 621682201 - COLUMBIA MEDICAL CENTER OF ARLINGTON SUBSIDIARY LP | TX | General Acute Care Hospital (282N00000X) |
United | 96571 | $3248.00 | 1992776405 - HCA HEALTH SERVICES OF TENNESSEE, INC., TRISTAR STONECREST MEDICAL CENTER | 621113737 - HCA HEALTH SERVICES OF TENNESSEE INC | TN | General Acute Care Hospital (282N00000X) |
United | 96571 | $1948.00 | 1013010917 - COMMUNITY MEDICAL CENTER INC | 223452306 | NJ | 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 | $4376.00 | 1073550133 - TERRE HAUTE REGIONAL HOSPITAL, L.P., TERRE HAUTE REGIONAL HOSPITAL | 351461805 - (IN) TERRE HAUTE REGIONAL HOSPITAL LP | IN | General Acute Care Hospital (282N00000X) |
United | 96571 | $1400.00 | 1922031541 - TEXAS HEALTH HARRIS METHODIST HOSPITAL STEPHENVILLE | 751752253 - (TX) TEXAS HEALTH HARRIS METHODIST HOSPITAL STEPHENVILLE | TX | General Acute Care Hospital (282N00000X) |
United | 96571 | $548.00 | 1780930412 - UNIVERSITY HOSPITALS AHUJA MEDICAL CENTER | 264827222 - (OH) UNIVERSITY HOSPITALS HEALTH SYSTEM INC | OH | General Acute Care Hospital (282N00000X) |
United | 96571 | $3151.00 | 1265486278 - EAST GEORGIA REGIONAL MEDICAL CENTER, LLC, EAST GEORGIA REGIONAL MEDICAL CENTER LLC | 582190713 - (GA) EAST GEORGIA REGIONAL MEDICAL CENTER LLC | GA | General Acute Care Hospital (282N00000X) |
United | 96571 | $296.00 | 1881613909 - TAKOMA HOSPITAL & SANITARIUM TRAINING SCHOOL, INC., TAKOMA ADVENTIST HOSPITAL | 510603966 - TAKOMA REGIONAL HOSPITAL INC | TN | Rural Acute Care Hospital (282NR1301X) |
United | 96571 | $6291.00 | 1912014564 - ADVOCATE NORTH SIDE HEALTH NETWORK, ADVOCATE ILLINOIS MASONIC MEDICAL CENTER | 363196629 - (IL) ADVOCATE NORTH SIDE HEALTH NETWORK | IL | General Acute Care Hospital (282N00000X) |
United | 96571 | $542.00 | 1851642540 - HOUSTON COUNTY COMMUNITY HOSPITAL | 462490116 | 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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