CPT code 96573: Photodynamic therapy, includes agent application2026 Medicare rate & RVUs in Montana
Reports physician- or QHP-performed photodynamic treatment of premalignant skin or adjacent mucosal lesions, including application of photosensitizing agent when performed.
In Montana, Medicare pays $217.44 for 96573 in the office.
Check a contract rate as a % of Medicare · 96573 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 96573 covers
Code 96573 describes photodynamic treatment of premalignant lesions of the skin or adjacent mucosa using an applied photosensitizer and external light. Dermatologists commonly use it for actinic keratoses, such as lesions on the face or scalp. A physician or other qualified health care professional performs the service in an office or outpatient setting; the code includes application of the photosensitizing agent when performed.
Report the service per treatment day, rather than per lesion or light-treatment interval. Documentation should identify the treated sites, the photosensitizer application when performed, and the light treatment. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. Modifier 50 is inappropriate for this service. Assistant-at-surgery payment requires documentation of medical necessity; co-surgeons and team surgery are not permitted.
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 Montana compares for 96573
Across 109 of 109 payment localities, the office rate for 96573 runs from $188.76 in Arkansas to $307.73 in San Benito County, CA. Montana pays $217.44. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Montana · this page$217.44
- Los Angeles, CA · California$254.66+$37.22
- Washington, DC area · District of Columbia$254.15+$36.71
- Miami, FL · Florida$226.71+$9.27
- Chicago, IL · Illinois$219.42+$1.98
- Manhattan, NY · New York$251.41+$33.97
- Alaska · Alaska$238.06+$20.62
Other areas in Montana first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $192.02 | — |
| ArkansasArkansas | $188.76 | — |
| ArizonaArizona | $211.11 | — |
| Bakersfield, CACalifornia | $236.78 | — |
| Chico, CACalifornia | $236.70 | — |
| El Centro, CACalifornia | $236.70 | — |
| Fresno, CACalifornia | $236.70 | — |
| Hanford, CACalifornia | $236.70 | — |
| Madera, CACalifornia | $236.70 | — |
| Merced, CACalifornia | $236.70 | — |
| Modesto, CACalifornia | $236.70 | — |
| Napa, CACalifornia | $282.04 | — |
| Oxnard, CACalifornia | $254.22 | — |
| Redding, CACalifornia | $236.70 | — |
| Rest of CaliforniaCalifornia | $236.70 | — |
| Riverside, CACalifornia | $236.93 | — |
| Sacramento, CACalifornia | $250.47 | — |
| Salinas, CACalifornia | $249.59 | — |
| San Diego, CACalifornia | $257.02 | — |
| Marin County, CACalifornia | $301.01 | — |
| San Francisco, CACalifornia | $300.99 | — |
| San Benito County, CACalifornia | $307.73 | — |
| Santa Clara County, CACalifornia | $307.64 | — |
| San Luis Obispo, CACalifornia | $245.35 | — |
| Santa Cruz, CACalifornia | $260.69 | — |
| Santa Maria, CACalifornia | $250.95 | — |
| Santa Rosa, CACalifornia | $263.45 | — |
| Stockton, CACalifornia | $236.70 | — |
| Vallejo, CACalifornia | $282.01 | — |
| Visalia, CACalifornia | $236.70 | — |
| Yuba City, CACalifornia | $236.70 | — |
| ColoradoColorado | $230.35 | — |
| ConnecticutConnecticut | $233.38 | — |
| DelawareDelaware | $215.04 | — |
| Fort Lauderdale, FLFlorida | $220.59 | — |
| Rest of FloridaFlorida | $208.93 | — |
| Atlanta, GAGeorgia | $220.84 | — |
| Rest of GeorgiaGeorgia | $195.85 | — |
| Hawaii, Guam, HIHawaii | $244.71 | — |
| IowaIowa | $199.95 | — |
| IdahoIdaho | $201.00 | — |
| East St. Louis, ILIllinois | $202.03 | — |
| Rest of IllinoisIllinois | $200.32 | — |
| Suburban Chicago, ILIllinois | $223.49 | — |
| IndianaIndiana | $202.42 | — |
| KansasKansas | $197.81 | — |
| KentuckyKentucky | $195.06 | — |
| New Orleans, LALouisiana | $205.67 | — |
| Rest of LouisianaLouisiana | $194.29 | — |
| Metropolitan Boston, MAMassachusetts | $257.02 | — |
| Rest of MassachusettsMassachusetts | $228.21 | — |
| Baltimore area, MDMaryland | $232.53 | — |
| Rest of MarylandMaryland | $219.95 | — |
| Rest of MaineMaine | $201.10 | — |
| Southern Maine, MEMaine | $215.38 | — |
| Detroit, MIMichigan | $210.86 | — |
| Rest of MichiganMichigan | $200.03 | — |
| MinnesotaMinnesota | $222.80 | — |
| Metropolitan Kansas City, MOMissouri | $205.16 | — |
| Metropolitan St. Louis, MOMissouri | $207.79 | — |
| Rest of MissouriMissouri | $189.67 | — |
| MississippiMississippi | $189.32 | — |
| North CarolinaNorth Carolina | $203.73 | — |
| North DakotaNorth Dakota | $217.04 | — |
| NebraskaNebraska | $201.54 | — |
| New HampshireNew Hampshire | $225.60 | — |
| Northern New JerseyNew Jersey | $250.65 | — |
| Rest of New JerseyNew Jersey | $236.63 | — |
| New MexicoNew Mexico | $200.89 | — |
| NevadaNevada | $217.53 | — |
| NYC suburbs and Long Island, NYNew York | $257.02 | — |
| Poughkeepsie and northern NYC suburbs, NYNew York | $237.39 | — |
| Queens, NYNew York | $255.34 | — |
| Rest of New YorkNew York | $207.19 | — |
| OhioOhio | $199.95 | — |
| OklahomaOklahoma | $195.78 | — |
| Portland, OROregon | $239.84 | — |
| Rest of OregonOregon | $216.44 | — |
| Metropolitan Philadelphia, PAPennsylvania | $226.10 | — |
| Rest of PennsylvaniaPennsylvania | $200.92 | — |
| Puerto RicoPuerto Rico | $219.64 | — |
| Rhode IslandRhode Island | $224.30 | — |
| South CarolinaSouth Carolina | $202.06 | — |
| South DakotaSouth Dakota | $217.00 | — |
| TennesseeTennessee | $198.83 | — |
| Austin, TXTexas | $229.06 | — |
| Beaumont, TXTexas | $199.30 | — |
| Brazoria, TXTexas | $215.61 | — |
| Dallas, TXTexas | $216.68 | — |
| Fort Worth, TXTexas | $214.68 | — |
| Galveston, TXTexas | $216.04 | — |
| Houston, TXTexas | $216.41 | — |
| Rest of TexasTexas | $207.12 | — |
| UtahUtah | $205.31 | — |
| VirginiaVirginia | $213.83 | — |
| Virgin Islands, VIUnited States Virgin Islands | $219.64 | — |
| VermontVermont | $215.10 | — |
| Rest of WashingtonWashington | $228.14 | — |
| King County, WAWashington | $263.75 | — |
| WisconsinWisconsin | $208.53 | — |
| West VirginiaWest Virginia | $191.39 | — |
| WyomingWyoming | $217.27 | — |
96573 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.
$188.76
$272.22
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 | $238.06 | 1 |
| AL | $192.02 | 1 |
| AR | $188.76 | 1 |
| AZ | $211.11 | 1 |
| CA | $236.70–$307.73 | 29 |
| CO | $230.35 | 1 |
| CT | $233.38 | 1 |
| DC | $254.15 | 1 |
| DE | $215.04 | 1 |
| FL | $208.93–$226.71 | 3 |
| GA | $195.85–$220.84 | 2 |
| GU | $244.71 | 1 |
| HI | $244.71 | 1 |
| IA | $199.95 | 1 |
| ID | $201.00 | 1 |
| IL | $200.32–$223.49 | 4 |
| IN | $202.42 | 1 |
| KS | $197.81 | 1 |
| KY | $195.06 | 1 |
| LA | $194.29–$205.67 | 2 |
| MA | $228.21–$257.02 | 2 |
| MD | $219.95–$254.15 | 3 |
| ME | $201.10–$215.38 | 2 |
| MI | $200.03–$210.86 | 2 |
| MN | $222.80 | 1 |
| MO | $189.67–$207.79 | 3 |
| MS | $189.32 | 1 |
| MT | $217.44 | 1 |
| NC | $203.73 | 1 |
| ND | $217.04 | 1 |
| NE | $201.54 | 1 |
| NH | $225.60 | 1 |
| NJ | $236.63–$250.65 | 2 |
| NM | $200.89 | 1 |
| NV | $217.53 | 1 |
| NY | $207.19–$257.02 | 5 |
| OH | $199.95 | 1 |
| OK | $195.78 | 1 |
| OR | $216.44–$239.84 | 2 |
| PA | $200.92–$226.10 | 2 |
| PR | $219.64 | 1 |
| RI | $224.30 | 1 |
| SC | $202.06 | 1 |
| SD | $217.00 | 1 |
| TN | $198.83 | 1 |
| TX | $199.30–$229.06 | 8 |
| UT | $205.31 | 1 |
| VA | $213.83–$254.15 | 2 |
| VI | $219.64 | 1 |
| VT | $215.10 | 1 |
| WA | $228.14–$263.75 | 2 |
| WI | $208.53 | 1 |
| WV | $191.39 | 1 |
| WY | $217.27 | 1 |
How the 96573 rate is calculated
Each of 96573’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 · 96573
RVUs × geographic indexes × conversion factor
Work0.47
0.47 RVUs× 1.000 GPCI
Practice expense6.02
6.02 RVUs× 1.000 GPCI
Malpractice0.02
0.02 RVUs× 1.000 GPCI
Adjusted RVUs
6.5100
Conversion factor
$33.4009
Medicare rate
$217.44
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Montana inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
12,822
- Code
- 96573
- Physician work
- 0.47
- Practice expense
- 6.02
- Malpractice
- 0.02
GPCI2026.csv
71
- Locality
- Montana
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.998
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.47 | × 1.000 | 0.4700 |
| Practice expense | 6.02 | × 1.000 | 6.0200 |
| Malpractice | 0.02 | × 0.998 | 0.0200 |
| Total RVUs | 6.5100 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Montana$217.44
Office: (0.47 × 1 + 6.02 × 1 + 0.02 × 0.998) × $33.4009 = $217.44
Payment rules and modifiers for 96573
The CMS indicators that decide how 96573 is paid alongside other services.
CMS payment indicators · 96573
Photodynamic therapy, includes agent application
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| 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 | 0 | Physician service: no professional/technical split. |
How 96573 has changed in Montana
96573 · Office / nonfacility
$217.44
Effective 2026-10-01
The base rate is $4.61 higher than on 2025-10-01, moving from $212.83 to $217.44 (2.2%).
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
$212.83changed to$217.44
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 0.48 changed to 0.47
- Practice expense RVU 6.08 changed to 6.02
- Malpractice GPCI 0.978 changed to 0.998
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$226.34changed to$212.83
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 6.30 changed to 6.08
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$222.65changed to$226.34
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$233.81changed to$222.65
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 6.40 changed to 6.30
January 1, 2023
RVU23A
$241.19changed to$233.81
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 6.47 changed to 6.40
- Malpractice GPCI 0.977 changed to 0.978
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$240.75changed to$241.19
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 6.40 changed to 6.47
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$217.84changed to$240.75
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 5.53 changed to 6.40
- Malpractice GPCI 1.304 changed to 0.977
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$206.11changed to$217.84
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 5.19 changed to 5.53
- Malpractice RVU 0.03 changed to 0.02
- Malpractice GPCI 1.631 changed to 1.304
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$194.00changed to$206.11
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 4.86 changed to 5.19
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
No ratechanged to$194.00
Held through RVU18B, RVU18C, RVU18D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D, RVU16A, RVU16B, RVU16C, RVU16D, RVU17A, RVU17B, RVU17C, RVU17D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $217.44 | Not available in this setting | RVU26D |
| 2026-07-01 | $217.44 | Not available in this setting | RVU26C |
| 2026-04-01 | $217.44 | Not available in this setting | RVU26B |
| 2026-01-01 | $217.44 | Not available in this setting | RVU26A |
| 2025-10-01 | $212.83 | Not available in this setting | RVU25D |
| 2025-07-01 | $212.83 | Not available in this setting | RVU25C |
| 2025-04-01 | $212.83 | Not available in this setting | RVU25B |
| 2025-01-01 | $212.83 | Not available in this setting | RVU25A |
| 2024-10-01 | $226.34 | Not available in this setting | RVU24D |
| 2024-07-01 | $226.34 | Not available in this setting | RVU24C |
| 2024-04-01 | $226.34 | Not available in this setting | RVU24B |
| 2024-03-09 | $226.34 | Not available in this setting | RVU24AR |
| 2024-01-01 | $222.65 | Not available in this setting | RVU24A |
| 2023-10-01 | $233.81 | Not available in this setting | RVU23D |
| 2023-07-01 | $233.81 | Not available in this setting | RVU23C |
| 2023-04-01 | $233.81 | Not available in this setting | RVU23B |
| 2023-01-01 | $233.81 | Not available in this setting | RVU23A |
| 2022-10-01 | $241.19 | Not available in this setting | RVU22D |
| 2022-07-01 | $241.19 | Not available in this setting | RVU22C |
| 2022-04-01 | $241.19 | Not available in this setting | RVU22B |
| 2022-01-01 | $241.19 | Not available in this setting | RVU22A |
| 2021-10-01 | $240.75 | Not available in this setting | RVU21D |
| 2021-07-01 | $240.75 | Not available in this setting | RVU21C |
| 2021-04-01 | $240.75 | Not available in this setting | RVU21B |
| 2021-01-01 | $240.75 | Not available in this setting | RVU21A |
| 2020-10-01 | $217.84 | Not available in this setting | RVU20D |
| 2020-07-01 | $217.84 | Not available in this setting | RVU20C |
| 2020-04-01 | $217.84 | Not available in this setting | RVU20B |
| 2020-01-01 | $217.84 | Not available in this setting | RVU20A |
| 2019-10-01 | $206.11 | Not available in this setting | RVU19D |
| 2019-07-01 | $206.11 | Not available in this setting | RVU19C |
| 2019-04-01 | $206.11 | Not available in this setting | RVU19B |
| 2019-01-01 | $206.11 | Not available in this setting | RVU19A |
| 2018-10-01 | $194.00 | Not available in this setting | RVU18D |
| 2018-07-01 | $194.00 | Not available in this setting | RVU18C |
| 2018-04-01 | $194.00 | Not available in this setting | RVU18B |
| 2018-01-01 | $194.00 | Not available in this setting | RVU18AR1 |
| 2017-10-01 | Not in this release | Not in this release | RVU17D |
| 2017-07-01 | Not in this release | Not in this release | RVU17C |
| 2017-04-01 | Not in this release | Not in this release | RVU17B |
| 2017-01-01 | Not in this release | Not in this release | RVU17A |
| 2016-10-01 | Not in this release | Not in this release | RVU16D |
| 2016-07-01 | Not in this release | Not in this release | RVU16C |
| 2016-04-01 | Not in this release | Not in this release | RVU16B |
| 2016-01-01 | Not in this release | Not in this release | RVU16A |
| 2015-10-01 | Not in this release | Not in this release | RVU15D |
| 2015-07-01 | Not in this release | Not in this release | RVU15C |
| 2015-04-01 | Not in this release | Not in this release | RVU15B |
| 2015-01-01 | Not in this release | Not in this release | RVU15A |
| 2014-10-01 | Not in this release | Not in this release | RVU14D |
| 2014-07-01 | Not in this release | Not in this release | RVU14C |
| 2014-04-01 | Not in this release | Not in this release | RVU14B |
| 2014-01-01 | Not in this release | Not in this release | RVU14A |
| 2013-10-01 | Not in this release | Not in this release | RVU13D |
| 2013-07-01 | Not in this release | Not in this release | RVU13C |
| 2013-04-01 | Not in this release | Not in this release | RVU13B |
| 2013-01-01 | Not in this release | Not in this release | RVU13AR |
Where the Montana rate applies
Montana is a Medicare payment area, not a city. Our Census mapping connects it to 497 cities and communities in Montana. Some span more than one payment area; confirm with the service ZIP.
- Absarokee
- Acton
- Alberton
- Alder
- Alzada
- Amsterdam
- Anaconda-Deer Lodge County
- Antelope
96573 billing questions
How does 96573 differ from 96567?
Code 96573 includes application of the photosensitizing agent when performed. Code 96567 describes photodynamic treatment without that included agent-application element.
Is 96573 reported for each lesion?
No. It is reported per treatment day, not per lesion or light-treatment interval.
Can the photosensitizing drug be billed separately?
The drug may be separately reportable when supplied and applicable. For topical aminolevulinic acid, J7308 is a related drug code.
Should modifier 50 be used for lesions on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this service; report the treatment day rather than separate right- and left-side services.
What same-day care is included in the global period?
The 0-day global period includes same-day preoperative and postoperative care. The code is reported for the photodynamic treatment itself.
When can an assistant-at-surgery be paid?
Only when documentation establishes medical necessity. Co-surgeons and team surgery are not permitted.
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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