CPT code 96574: Lesion debridement, for photodynamic therapy2026 Medicare rate & RVUs

Medicare pays $266.87 for 96574 nationally in the office. Local office rates run $233.40–$372.75.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 96574 covers

This code covers a physician or other qualified health care professional’s debridement of premalignant hyperkeratotic lesions, such as actinic keratoses, to prepare the treated skin for photodynamic therapy. The service removes overlying scale or crust so the light-based treatment can reach the target lesions. It is used when that preparation is performed as part of a photodynamic therapy treatment, not for routine wound cleaning or lesion destruction by another method.

Report the service per day when the documentation identifies the treated area, the premalignant lesions, and the debridement performed to prepare them for photodynamic therapy. When the photodynamic treatment is also performed by a physician or qualified health care professional, 96573 may be reported for that treatment. Medicare assigns a 0-day global period, so same-day preoperative and postoperative care is included. Modifier 50 is inappropriate. Assistant-at-surgery payment requires documented 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.

Where 96574 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

96574 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 96574 rate is calculated

Each of 96574’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.

Payment rules and modifiers for 96574

The CMS indicators that decide how 96574 is paid alongside other services.

96574 compared with similar codes

How to choose

96573Photodynamic therapyIncludes agent application

96573 reports the photodynamic treatment itself by a physician or qualified health care professional; 96574 reports preparatory debridement.

96567Photodynamic therapyIncident-to treatment

96567 reports external-light photodynamic treatment of premalignant skin lesions. Use 96574 for the separate preparatory debridement, not for the light treatment.

17000Premalignant lesion destructionFirst lesion

17000 reports direct destruction of a premalignant lesion. 96574 is for debridement performed to prepare lesions for photodynamic therapy.

Codes related to 96574

Related codes aren’t interchangeable: bill the code that matches the service performed.

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

Open CMS sourceHow we calculate rates