CPT 96573 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 | • 11 - Office • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • 79 - Unrelated procedure - postop period |
| Complexity Level | Moderate |
National average reimbursement for CPT 96573 by major payers:
$284.67
$263.04
$270.20
$357.17
| 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 96573 | ||||||
United | 96573 | $1016.00 | 1275505372 - MARTIN HEALTH, WEST TENNESSEE HEALTHCARE VOLUNTEER HOSPITAL | 825187448 - (TN) MARTIN HEALTH | TN | General Acute Care Hospital (282N00000X) |
United | 96573 | $3202.00 | 1124272547 - ADVOCATE CONDELL MEDICAL CENTER | 262525968 - (IL) ADVOCATE HEALTH CARE NETWORK | IL | General Acute Care Hospital (282N00000X) |
United | 96573 | $200.50 | 1467409540 - MOLECULAR IMAGING OF SUBURBAN CHICAGO, LLC | 201675608 - (IL) MOLECULAR IMAGING OF SUBURBAN CHICAGO LLC | IL | Radiology Clinic/Center (261QR0200X) |
United | 96573 | $200.50 | 1265626436 - ADVANTAGE MRI-CAROL STREAM, LLC | 260810327 | IL | Radiology Clinic/Center (261QR0200X) |
United | 96573 | $644.00 | 1497702575 - ORANGE COAST MEMORIAL MEDICAL CENTER | 330687414 - (CA) MEMORIAL HEALTH SERVICES | CA | General Acute Care Hospital (282N00000X) |
United | 96573 | $2081.00 | 1184682874 - S P ACQUISITION CORP., GRANDVIEW MEDICAL CENTER | 620840204 | TN | General Acute Care Hospital (282N00000X) |
United | 96573 | $189.00 | 1023013935 - MCCAMEY COUNTY HOSPITAL DISTRICT | 751246166 - (TX) MCCAMEY COUNTY HOSPITAL DISTRICT | TX | Critical Access Hospital (282NC0060X) |
United | 96573 | $294.00 | 1104857119 - PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA, JACKSON NORTH MEDICAL CENTER | 591713947 - (FL) PUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY FLORIDA | FL | General Acute Care Hospital (282N00000X) |
United | 96573 | $3336.00 | 1831197508 - MERIDIAN HOSPITALS CORPORATION, BAYSHORE COMMUNITY HOSPITAL | 221487576 - HACKENSACK MERIDIAN HEALTH INC | NJ | General Acute Care Hospital (282N00000X) |
United | 96573 | $9906.00 | 1477671535 - DIGNITY HEALTH, MERCY MEDICAL CENTER REDDING | 562360411 | CA | General Acute Care Hospital (282N00000X) |
United | 96573 | $648.00 | 1164447850 - PUBLIC HOSPITAL DISTRICT NO 2 SKAGIT COUNTY WASHINGTON, ISLAND HOSPITAL | 910729255 - (WA) PUBLIC HOSPITAL DISTRICT NO 2 | WA | General Acute Care Hospital (282N00000X) |
United | 96573 | $1883.00 | 1700910189 - DIGNITY COMMUNITY CARE, CHANDLER REGIONAL MEDICAL CENTER | 721561132 | AZ | General Acute Care Hospital (282N00000X) |
United | 96573 | $1880.00 | 1841843455 - HCN EP HORIZON CITY, LLC, THE HOSPITALS OF PROVIDENCE EMERGENCY ROOM MONTWOOD | 813935393 - (TX) HCN EP HORIZON CITY LLC | TX | General Acute Care Hospital (282N00000X) |
United | 96573 | $133.00 | 1740524511 - TYRONE HOSPITAL | 231440116 - (PA) TYRONE HOSPITAL | PA | Critical Access Hospital (282NC0060X) |
United | 96573 | $1593.00 | 1629071758 - BRIGHTON COMMUNITY HOSPITAL ASSOCIATION, INTERMOUNTAIN HEALTH PLATTE VALLEY HOSPITAL | 840482695 - (CO) BRIGHTON COMMUNITY HOSPITAL ASSOCIATION | CO | 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 96573 vs. Other Photodynamic Therapy Procedures Codes
The CPT 96573 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 96573 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 96573. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96573 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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