CPT code 96567: Photodynamic therapy, incident-to treatment2026 Medicare rate & RVUs in Delaware
Reports an external-light photodynamic treatment using a photosensitizing agent to destroy premalignant lesions of the skin or adjacent mucosa.
In Delaware, Medicare pays $127.68 for 96567 in the office.
Check a contract rate as a % of Medicare · 96567 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What 96567 covers
This service treats premalignant lesions, commonly actinic keratoses on sun-damaged skin such as the face or scalp, with a photosensitizing agent followed by external illumination. The treatment is typically furnished in a dermatology office, with clinical staff performing the service under physician supervision. The light activates the agent in the treated area to damage the targeted abnormal cells.
Report one unit for each treatment, rather than one unit per lesion. Documentation should identify the treated area, photosensitizing agent, light treatment, and physician supervision. Under the CMS rule for this code, Medicare billing is limited to performance under physician supervision as an incident-to service. When a physician or other qualified health care professional performs the photodynamic treatment, distinguish that service from this staff-performed code and consider 96573. Separate lesion debridement performed to prepare for photodynamic therapy may be reported with 96574 when supported by the documentation.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
How Delaware compares for 96567
Across 109 of 109 payment localities, the office rate for 96567 runs from $110.92 in Arkansas to $186.09 in San Benito County, CA. Delaware pays $127.68. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Delaware · this page$127.68
- Los Angeles, CA · California$152.74+$25.06
- Washington, DC area · District of Columbia$152.25+$24.57
- Miami, FL · Florida$135.06+$7.38
- Chicago, IL · Illinois$130.34+$2.66
- Manhattan, NY · New York$150.34+$22.66
- Alaska · Alaska$137.49+$9.81
Other areas in Delaware first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $113.00 | — |
| ArkansasArkansas | $110.92 | — |
| ArizonaArizona | $125.22 | — |
| Bakersfield, CACalifornia | $141.51 | — |
| Chico, CACalifornia | $141.48 | — |
| El Centro, CACalifornia | $141.49 | — |
| Fresno, CACalifornia | $141.48 | — |
| Hanford, CACalifornia | $141.48 | — |
| Madera, CACalifornia | $141.48 | — |
| Merced, CACalifornia | $141.48 | — |
| Modesto, CACalifornia | $141.48 | — |
| Napa, CACalifornia | $170.10 | — |
| Oxnard, CACalifornia | $152.60 | — |
| Redding, CACalifornia | $141.48 | — |
| Rest of CaliforniaCalifornia | $141.48 | — |
| Riverside, CACalifornia | $141.59 | — |
| Sacramento, CACalifornia | $150.12 | — |
| Salinas, CACalifornia | $149.61 | — |
| San Diego, CACalifornia | $154.38 | — |
| Marin County, CACalifornia | $181.94 | — |
| San Francisco, CACalifornia | $181.93 | — |
| San Benito County, CACalifornia | $186.09 | — |
| Santa Clara County, CACalifornia | $186.05 | — |
| San Luis Obispo, CACalifornia | $147.03 | — |
| Santa Cruz, CACalifornia | $156.83 | — |
| Santa Maria, CACalifornia | $150.51 | — |
| Santa Rosa, CACalifornia | $158.50 | — |
| Stockton, CACalifornia | $141.48 | — |
| Vallejo, CACalifornia | $170.08 | — |
| Visalia, CACalifornia | $141.48 | — |
| Yuba City, CACalifornia | $141.48 | — |
| ColoradoColorado | $137.44 | — |
| ConnecticutConnecticut | $139.26 | — |
| Fort Lauderdale, FLFlorida | $131.21 | — |
| Rest of FloridaFlorida | $123.76 | — |
| Atlanta, GAGeorgia | $131.39 | — |
| Rest of GeorgiaGeorgia | $115.40 | — |
| Hawaii, Guam, HIHawaii | $146.78 | — |
| IowaIowa | $118.10 | — |
| IdahoIdaho | $118.77 | — |
| East St. Louis, ILIllinois | $119.29 | — |
| Rest of IllinoisIllinois | $118.23 | — |
| Suburban Chicago, ILIllinois | $133.00 | — |
| IndianaIndiana | $119.68 | — |
| KansasKansas | $116.72 | — |
| KentuckyKentucky | $114.92 | — |
| New Orleans, LALouisiana | $121.70 | — |
| Rest of LouisianaLouisiana | $114.42 | — |
| Metropolitan Boston, MAMassachusetts | $154.24 | — |
| Rest of MassachusettsMassachusetts | $136.03 | — |
| Baltimore area, MDMaryland | $138.75 | — |
| Rest of MarylandMaryland | $130.78 | — |
| Rest of MaineMaine | $118.82 | — |
| Southern Maine, MEMaine | $127.98 | — |
| Detroit, MIMichigan | $124.98 | — |
| Rest of MichiganMichigan | $118.09 | — |
| MinnesotaMinnesota | $132.77 | — |
| Metropolitan Kansas City, MOMissouri | $121.39 | — |
| Metropolitan St. Louis, MOMissouri | $123.07 | — |
| Rest of MissouriMissouri | $111.46 | — |
| MississippiMississippi | $111.25 | — |
| MontanaMontana | $129.26 | — |
| North CarolinaNorth Carolina | $120.50 | — |
| North DakotaNorth Dakota | $129.06 | — |
| NebraskaNebraska | $119.13 | — |
| New HampshireNew Hampshire | $134.51 | — |
| Northern New JerseyNew Jersey | $149.91 | — |
| Rest of New JerseyNew Jersey | $141.16 | — |
| New MexicoNew Mexico | $118.63 | — |
| NevadaNevada | $129.33 | — |
| NYC suburbs and Long Island, NYNew York | $153.92 | — |
| Poughkeepsie and northern NYC suburbs, NYNew York | $141.58 | — |
| Queens, NYNew York | $152.87 | — |
| Rest of New YorkNew York | $122.72 | — |
| OhioOhio | $118.05 | — |
| OklahomaOklahoma | $115.39 | — |
| Portland, OROregon | $143.49 | — |
| Rest of OregonOregon | $128.65 | — |
| Metropolitan Philadelphia, PAPennsylvania | $134.61 | — |
| Rest of PennsylvaniaPennsylvania | $118.67 | — |
| Puerto RicoPuerto Rico | $130.67 | — |
| Rhode IslandRhode Island | $133.48 | — |
| South CarolinaSouth Carolina | $119.41 | — |
| South DakotaSouth Dakota | $129.04 | — |
| TennesseeTennessee | $117.37 | — |
| Austin, TXTexas | $136.70 | — |
| Beaumont, TXTexas | $117.63 | — |
| Brazoria, TXTexas | $128.03 | — |
| Dallas, TXTexas | $128.70 | — |
| Fort Worth, TXTexas | $127.41 | — |
| Galveston, TXTexas | $128.30 | — |
| Houston, TXTexas | $128.48 | — |
| Rest of TexasTexas | $122.65 | — |
| UtahUtah | $121.49 | — |
| VirginiaVirginia | $126.97 | — |
| Virgin Islands, VIUnited States Virgin Islands | $130.67 | — |
| VermontVermont | $127.81 | — |
| Rest of WashingtonWashington | $136.01 | — |
| King County, WAWashington | $158.47 | — |
| WisconsinWisconsin | $123.62 | — |
| West VirginiaWest Virginia | $112.52 | — |
| WyomingWyoming | $129.17 | — |
96567 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$110.92
$163.79
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $137.49 | 1 |
| AL | $113.00 | 1 |
| AR | $110.92 | 1 |
| AZ | $125.22 | 1 |
| CA | $141.48–$186.09 | 29 |
| CO | $137.44 | 1 |
| CT | $139.26 | 1 |
| DC | $152.25 | 1 |
| DE | $127.68 | 1 |
| FL | $123.76–$135.06 | 3 |
| GA | $115.40–$131.39 | 2 |
| GU | $146.78 | 1 |
| HI | $146.78 | 1 |
| IA | $118.10 | 1 |
| ID | $118.77 | 1 |
| IL | $118.23–$133.00 | 4 |
| IN | $119.68 | 1 |
| KS | $116.72 | 1 |
| KY | $114.92 | 1 |
| LA | $114.42–$121.70 | 2 |
| MA | $136.03–$154.24 | 2 |
| MD | $130.78–$152.25 | 3 |
| ME | $118.82–$127.98 | 2 |
| MI | $118.09–$124.98 | 2 |
| MN | $132.77 | 1 |
| MO | $111.46–$123.07 | 3 |
| MS | $111.25 | 1 |
| MT | $129.26 | 1 |
| NC | $120.50 | 1 |
| ND | $129.06 | 1 |
| NE | $119.13 | 1 |
| NH | $134.51 | 1 |
| NJ | $141.16–$149.91 | 2 |
| NM | $118.63 | 1 |
| NV | $129.33 | 1 |
| NY | $122.72–$153.92 | 5 |
| OH | $118.05 | 1 |
| OK | $115.39 | 1 |
| OR | $128.65–$143.49 | 2 |
| PA | $118.67–$134.61 | 2 |
| PR | $130.67 | 1 |
| RI | $133.48 | 1 |
| SC | $119.41 | 1 |
| SD | $129.04 | 1 |
| TN | $117.37 | 1 |
| TX | $117.63–$136.70 | 8 |
| UT | $121.49 | 1 |
| VA | $126.97–$152.25 | 2 |
| VI | $130.67 | 1 |
| VT | $127.81 | 1 |
| WA | $136.01–$158.47 | 2 |
| WI | $123.62 | 1 |
| WV | $112.52 | 1 |
| WY | $129.17 | 1 |
How the 96567 rate is calculated
Each of 96567’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 96567
RVUs × geographic indexes × conversion factor
Work0.00
0.00 RVUs× 1.000 GPCI
Practice expense3.86
3.86 RVUs× 1.000 GPCI
Malpractice0.01
0.01 RVUs× 1.000 GPCI
Adjusted RVUs
3.8700
Conversion factor
$33.4009
Medicare rate
$129.26
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Delaware inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
12,819
- Code
- 96567
- Physician work
- 0.00
- Practice expense
- 3.86
- Malpractice
- 0.01
GPCI2026.csv
40
- Locality
- Delaware
- Physician work
- 1.005
- Practice expense
- 0.988
- Malpractice
- 0.899
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.00 | × 1.005 | 0.0000 |
| Practice expense | 3.86 | × 0.988 | 3.8137 |
| Malpractice | 0.01 | × 0.899 | 0.0090 |
| Total RVUs | 3.8227 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Delaware$127.68
Office: (0 × 1.005 + 3.86 × 0.988 + 0.01 × 0.899) × $33.4009 = $127.68
Payment rules and modifiers for 96567
The CMS indicators that decide how 96567 is paid alongside other services.
CMS payment indicators · 96567
Photodynamic therapy, incident-to treatment
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 5 | Incident-to service. |
How 96567 has changed in Delaware
96567 · Office / nonfacility
$127.68
Effective 2026-10-01
The base rate is $0.95 higher than on 2025-10-01, moving from $126.73 to $127.68 (0.7%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2026
RVU26A
$126.73changed to$127.68
- Conversion factor 32.3465 changed to 33.4009
- Practice expense RVU 3.94 changed to 3.86
- Work GPCI 1.009 changed to 1.005
- Practice expense GPCI 0.992 changed to 0.988
- Malpractice GPCI 0.949 changed to 0.899
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$135.70changed to$126.73
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 4.10 changed to 3.94
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$133.49changed to$135.70
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$143.64changed to$133.49
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 4.20 changed to 4.10
- Work GPCI 1.007 changed to 1.009
- Practice expense GPCI 1.007 changed to 0.992
- Malpractice GPCI 0.938 changed to 0.949
January 1, 2023
RVU23A
$151.69changed to$143.64
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 4.28 changed to 4.20
- Work GPCI 1.005 changed to 1.007
- Practice expense GPCI 1.022 changed to 1.007
- Malpractice GPCI 0.927 changed to 0.938
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$151.53changed to$151.69
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 4.24 changed to 4.28
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$138.92changed to$151.53
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 3.76 changed to 4.24
- Work GPCI 1.006 changed to 1.005
- Practice expense GPCI 1.021 changed to 1.022
- Malpractice GPCI 1.023 changed to 0.927
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$128.57changed to$138.92
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 3.49 changed to 3.76
- Work GPCI 1.007 changed to 1.006
- Practice expense GPCI 1.019 changed to 1.021
- Malpractice GPCI 1.119 changed to 1.023
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$118.89changed to$128.57
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 3.23 changed to 3.49
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$140.58changed to$118.89
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 3.80 changed to 3.23
- Malpractice RVU 0.02 changed to 0.01
- Work GPCI 1.010 changed to 1.007
- Practice expense GPCI 1.025 changed to 1.019
- Malpractice GPCI 1.101 changed to 1.119
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$140.68changed to$140.58
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 3.79 changed to 3.80
- Work GPCI 1.012 changed to 1.010
- Practice expense GPCI 1.031 changed to 1.025
- Malpractice GPCI 1.083 changed to 1.101
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$140.43changed to$140.68
- Conversion factor 35.9335 changed to 35.8043
- Practice expense RVU 3.78 changed to 3.79
- Malpractice RVU 0.01 changed to 0.02
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$139.73changed to$140.43
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$137.15changed to$139.73
- Conversion factor 35.8228 changed to 35.7547
- Practice expense RVU 3.68 changed to 3.78
- Practice expense GPCI 1.038 changed to 1.031
- Malpractice GPCI 0.878 changed to 1.083
Held through RVU15B.
January 1, 2014
RVU14A
$150.12changed to$137.15
- Conversion factor 34.0230 changed to 35.8228
- Practice expense RVU 4.22 changed to 3.68
- Practice expense GPCI 1.044 changed to 1.038
- Malpractice GPCI 0.672 changed to 0.878
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $150.12
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $127.68 | Not available in this setting | RVU26D |
| 2026-07-01 | $127.68 | Not available in this setting | RVU26C |
| 2026-04-01 | $127.68 | Not available in this setting | RVU26B |
| 2026-01-01 | $127.68 | Not available in this setting | RVU26A |
| 2025-10-01 | $126.73 | Not available in this setting | RVU25D |
| 2025-07-01 | $126.73 | Not available in this setting | RVU25C |
| 2025-04-01 | $126.73 | Not available in this setting | RVU25B |
| 2025-01-01 | $126.73 | Not available in this setting | RVU25A |
| 2024-10-01 | $135.70 | Not available in this setting | RVU24D |
| 2024-07-01 | $135.70 | Not available in this setting | RVU24C |
| 2024-04-01 | $135.70 | Not available in this setting | RVU24B |
| 2024-03-09 | $135.70 | Not available in this setting | RVU24AR |
| 2024-01-01 | $133.49 | Not available in this setting | RVU24A |
| 2023-10-01 | $143.64 | Not available in this setting | RVU23D |
| 2023-07-01 | $143.64 | Not available in this setting | RVU23C |
| 2023-04-01 | $143.64 | Not available in this setting | RVU23B |
| 2023-01-01 | $143.64 | Not available in this setting | RVU23A |
| 2022-10-01 | $151.69 | Not available in this setting | RVU22D |
| 2022-07-01 | $151.69 | Not available in this setting | RVU22C |
| 2022-04-01 | $151.69 | Not available in this setting | RVU22B |
| 2022-01-01 | $151.69 | Not available in this setting | RVU22A |
| 2021-10-01 | $151.53 | Not available in this setting | RVU21D |
| 2021-07-01 | $151.53 | Not available in this setting | RVU21C |
| 2021-04-01 | $151.53 | Not available in this setting | RVU21B |
| 2021-01-01 | $151.53 | Not available in this setting | RVU21A |
| 2020-10-01 | $138.92 | Not available in this setting | RVU20D |
| 2020-07-01 | $138.92 | Not available in this setting | RVU20C |
| 2020-04-01 | $138.92 | Not available in this setting | RVU20B |
| 2020-01-01 | $138.92 | Not available in this setting | RVU20A |
| 2019-10-01 | $128.57 | Not available in this setting | RVU19D |
| 2019-07-01 | $128.57 | Not available in this setting | RVU19C |
| 2019-04-01 | $128.57 | Not available in this setting | RVU19B |
| 2019-01-01 | $128.57 | Not available in this setting | RVU19A |
| 2018-10-01 | $118.89 | Not available in this setting | RVU18D |
| 2018-07-01 | $118.89 | Not available in this setting | RVU18C |
| 2018-04-01 | $118.89 | Not available in this setting | RVU18B |
| 2018-01-01 | $118.89 | Not available in this setting | RVU18AR1 |
| 2017-10-01 | $140.58 | Not available in this setting | RVU17D |
| 2017-07-01 | $140.58 | Not available in this setting | RVU17C |
| 2017-04-01 | $140.58 | Not available in this setting | RVU17B |
| 2017-01-01 | $140.58 | Not available in this setting | RVU17A |
| 2016-10-01 | $140.68 | Not available in this setting | RVU16D |
| 2016-07-01 | $140.68 | Not available in this setting | RVU16C |
| 2016-04-01 | $140.68 | Not available in this setting | RVU16B |
| 2016-01-01 | $140.68 | Not available in this setting | RVU16A |
| 2015-10-01 | $140.43 | Not available in this setting | RVU15D |
| 2015-07-01 | $140.43 | Not available in this setting | RVU15C |
| 2015-04-01 | $139.73 | Not available in this setting | RVU15B |
| 2015-01-01 | $139.73 | Not available in this setting | RVU15A |
| 2014-10-01 | $137.15 | Not available in this setting | RVU14D |
| 2014-07-01 | $137.15 | Not available in this setting | RVU14C |
| 2014-04-01 | $137.15 | Not available in this setting | RVU14B |
| 2014-01-01 | $137.15 | Not available in this setting | RVU14A |
| 2013-10-01 | $150.12 | Not available in this setting | RVU13D |
| 2013-07-01 | $150.12 | Not available in this setting | RVU13C |
| 2013-04-01 | $150.12 | Not available in this setting | RVU13B |
| 2013-01-01 | $150.12 | Not available in this setting | RVU13AR |
Where the Delaware rate applies
Delaware is a Medicare payment area, not a city. Our Census mapping connects it to 79 cities and communities in Delaware. Some span more than one payment area; confirm with the service ZIP.
- Arden
- Ardencroft
- Ardentown
- Bear
- Bellefonte
- Bethany Beach
- Bethel
- Blades
96567 billing questions
Is 96567 reported for each lesion?
No. Report one unit for each photodynamic treatment, not for each individual actinic keratosis or other treated lesion.
How does 96567 differ from 96573?
96567 is the incident-to service performed under physician supervision. Use 96573 when the physician or other qualified health care professional performs the external-light photodynamic treatment.
Does 96567 require physician supervision?
Yes. CMS identifies this as an incident-to service and permits billing only when it is performed under physician supervision.
Can debridement be reported with the photodynamic treatment?
When a physician or other qualified health care professional separately performs debridement to prepare premalignant lesions for photodynamic therapy, 96574 may describe that service. Document the debridement and its relationship to the treatment.
When might a destruction code be used instead?
Codes such as 17000 describe lesion destruction by methods other than photodynamic therapy. Choose the code that matches the procedure actually performed, not simply the diagnosis.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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