CPT 96574 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 • 79 - Unrelated procedure - postop period • 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
National average reimbursement for CPT 96574 by major payers:
$356.21
$333.91
$338.35
$442.18
| 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 96574 | ||||||
United | 96574 | $196.50 | 1720544810 - RACHEL HENSHAW | 593549147 | FL | Family Nurse Practitioner (363LF0000X) |
United | 96574 | $158.92 | 1346909421 - EDMUNDO BARRETO | 593549147 | FL | Family Nurse Practitioner (363LF0000X) |
United | 96574 | $158.92 | 1710438270 - COURTNEY COBAUGH | 593549147 | FL | Physician Assistant (363A00000X) |
United | 96574 | $196.50 | 1265043483 - JUDI FUSCO | 593549147 | FL | Dermatology Physician (207N00000X) |
United | 96574 | $158.92 | 1497343529 - AARON KENT | 593549147 | FL | Single Specialty Group (193400000X) |
United | 96574 | $196.50 | 1598166266 - ALEX RODRIGUEZ | 593549147 | FL | Physician Assistant (363A00000X) |
United | 96574 | $158.92 | 1033613898 - DANIELLE MARINO | 593549147 | FL | Nurse Practitioner (363L00000X) |
United | 96574 | $158.92 | 1497343529 - AARON KENT | 593549147 | FL | Physician Assistant (363A00000X) |
United | 96574 | $196.50 | 1508812983 - STEVEN PROPER | 593549147 | FL | MOHS-Micrographic Surgery Physician (207ND0101X) |
United | 96574 | $196.50 | 1497230320 - MIRABELLA MULLER | 593549147 | FL | Physician Assistant (363A00000X) |
United | 96574 | $158.92 | 1639254980 - ALICIA BROWN | 593549147 | FL | Medical Physician Assistant (363AM0700X) |
United | 96574 | $196.50 | 1669833232 - MICHAEL BARRERA | 593549147 | FL | Physician Assistant (363A00000X) |
United | 96574 | $196.50 | 1417981192 - WILLIAM CHOW | 593549147 | CA | Specialist (174400000X) |
United | 96574 | $196.50 | 1841285723 - MELINDA GREENFIELD | 593549147 | GA | Dermatology Physician (207N00000X) |
United | 96574 | $196.50 | 1841578309 - SHEILA KREIENBRINK | 593549147 | FL | Physician Assistant (363A00000X) |
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 96574 vs. Other Photodynamic Therapy Procedures Codes
The CPT 96574 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 96574 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) |
| 96574-CPT | Moderate | Debridement Of Premalignant Hyperkeratotic Lesion(S) (Ie Targeted Curettage Abrasion) Followed With 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 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 96574. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96574 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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