Both describe external-light photodynamic treatment of premalignant lesions. 96567 is the incident-to service under physician supervision; 96573 is for treatment performed by a physician or other qualified health care professional.
On this page
CMS RVU26D · Effective 2026-10-01
96567 in Madera
Office / nonfacility
$141.48
Base rate per service
Facility setting
Not available in this setting
Base rate per service
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
Dermatology procedure
About 96567: External-light photodynamic therapy for skin lesions
Reports an external-light photodynamic treatment using a photosensitizing agent to destroy premalignant lesions of the skin or adjacent mucosa.
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.
CMS billing rules for 96567
- Professional and technical components
- Incident-to service: billed only when performed under physician supervision.
Where the value comes from
- Work RVU0.00 · 0%
- Practice expense (office) RVU3.86 · 100%
- Malpractice RVU0.01 · 0%
44.4K
Medicare services in 2024 · #826 by national volume
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.
96567 compared with similar codes
Office rates for Madera, from the same CMS release.
96574 describes debridement that prepares premalignant lesions for photodynamic therapy, not the photosensitizer-and-light treatment itself.
17000 describes destruction of a first premalignant skin lesion using a method other than photodynamic therapy. Use 96567 when the documented treatment uses a photosensitizing agent and external light.
The same code, a different location
How does Madera compare?
In Bakersfield, the office rate for 96567 is $141.51—$0.03 higher than the $141.48 rate in Madera. Both use the same code, release and participation basis.
96567 across payment areas
Same release and payment basis · bars start at $0
Madera · This locality
$141.48
$141.51
$0.03 higher than Madera
$141.48
The same base rate than Madera
$141.49
$0.01 higher than Madera
$141.48
The same base rate than Madera
$141.48
The same base rate than Madera
$11.26 higher than Madera
Other payment areas listed in California appear first, followed by selected cross-country examples. The chart compares amounts, not distance.
Across 109 of 109 CMS payment localities with a supported office rate, 96567 ranges from $110.92 in Arkansas to $186.09 in San Jose-Sunnyvale-Santa Clara (San Benito Cnty). This is a geographic range, not an average.
The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.
Compare all 108 other payment areas
Merced
California · 96567
Office
$141.48
Facility
Unavailable
The same base rate than Madera for the office setting.
Modesto
California · 96567
Office
$141.48
Facility
Unavailable
The same base rate than Madera for the office setting.
Napa
California · 96567
Office
$170.10
Facility
Unavailable
$28.62 higher than Madera for the office setting.
Oxnard-Thousand Oaks-Ventura
California · 96567
Office
$152.60
Facility
Unavailable
$11.12 higher than Madera for the office setting.
Redding
California · 96567
Office
$141.48
Facility
Unavailable
The same base rate than Madera for the office setting.
Rest Of California
California · 96567
Office
$141.48
Facility
Unavailable
The same base rate than Madera for the office setting.
Riverside-San Bernardino-Ontario
California · 96567
Office
$141.59
Facility
Unavailable
$0.11 higher than Madera for the office setting.
Sacramento-Roseville-Folsom
California · 96567
Office
$150.12
Facility
Unavailable
$8.64 higher than Madera for the office setting.
Salinas
California · 96567
Office
$149.61
Facility
Unavailable
$8.13 higher than Madera for the office setting.
San Diego-Chula Vista-Carlsbad
California · 96567
Office
$154.38
Facility
Unavailable
$12.90 higher than Madera for the office setting.
San Francisco-Oakland-Berkeley (Marin Cnty)
California · 96567
Office
$181.94
Facility
Unavailable
$40.46 higher than Madera for the office setting.
San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)
California · 96567
Office
$181.93
Facility
Unavailable
$40.45 higher than Madera for the office setting.
San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
California · 96567
Office
$186.09
Facility
Unavailable
$44.61 higher than Madera for the office setting.
San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)
California · 96567
Office
$186.05
Facility
Unavailable
$44.57 higher than Madera for the office setting.
San Luis Obispo-Paso Robles
California · 96567
Office
$147.03
Facility
Unavailable
$5.55 higher than Madera for the office setting.
Santa Cruz-Watsonville
California · 96567
Office
$156.83
Facility
Unavailable
$15.35 higher than Madera for the office setting.
Santa Maria-Santa Barbara
California · 96567
Office
$150.51
Facility
Unavailable
$9.03 higher than Madera for the office setting.
Santa Rosa-Petaluma
California · 96567
Office
$158.50
Facility
Unavailable
$17.02 higher than Madera for the office setting.
Stockton
California · 96567
Office
$141.48
Facility
Unavailable
The same base rate than Madera for the office setting.
Vallejo
California · 96567
Office
$170.08
Facility
Unavailable
$28.60 higher than Madera for the office setting.
Visalia
California · 96567
Office
$141.48
Facility
Unavailable
The same base rate than Madera for the office setting.
Yuba City
California · 96567
Office
$141.48
Facility
Unavailable
The same base rate than Madera for the office setting.
Dc + Md/Va Suburbs
District of Columbia · 96567
Office
$152.25
Facility
Unavailable
$10.77 higher than Madera for the office setting.
Miami
Florida · 96567
Office
$135.06
Facility
Unavailable
$6.42 lower than Madera for the office setting.
Chicago
Illinois · 96567
Office
$130.34
Facility
Unavailable
$11.14 lower than Madera for the office setting.
Manhattan
New York · 96567
Office
$150.34
Facility
Unavailable
$8.86 higher than Madera for the office setting.
Alaska*
Alaska · 96567
Office
$137.49
Facility
Unavailable
$3.99 lower than Madera for the office setting.
Alabama
Alabama · 96567
Office
$113.00
Facility
Unavailable
$28.48 lower than Madera for the office setting.
Arkansas
Arkansas · 96567
Office
$110.92
Facility
Unavailable
$30.56 lower than Madera for the office setting.
Arizona
Arizona · 96567
Office
$125.22
Facility
Unavailable
$16.26 lower than Madera for the office setting.
Colorado
Colorado · 96567
Office
$137.44
Facility
Unavailable
$4.04 lower than Madera for the office setting.
Connecticut
Connecticut · 96567
Office
$139.26
Facility
Unavailable
$2.22 lower than Madera for the office setting.
Delaware
Delaware · 96567
Office
$127.68
Facility
Unavailable
$13.80 lower than Madera for the office setting.
Fort Lauderdale
Florida · 96567
Office
$131.21
Facility
Unavailable
$10.27 lower than Madera for the office setting.
Rest Of Florida
Florida · 96567
Office
$123.76
Facility
Unavailable
$17.72 lower than Madera for the office setting.
Atlanta
Georgia · 96567
Office
$131.39
Facility
Unavailable
$10.09 lower than Madera for the office setting.
Rest Of Georgia
Georgia · 96567
Office
$115.40
Facility
Unavailable
$26.08 lower than Madera for the office setting.
Hawaii, Guam
Hawaii · 96567
Office
$146.78
Facility
Unavailable
$5.30 higher than Madera for the office setting.
Iowa
Iowa · 96567
Office
$118.10
Facility
Unavailable
$23.38 lower than Madera for the office setting.
Idaho
Idaho · 96567
Office
$118.77
Facility
Unavailable
$22.71 lower than Madera for the office setting.
East St. Louis
Illinois · 96567
Office
$119.29
Facility
Unavailable
$22.19 lower than Madera for the office setting.
Rest Of Illinois
Illinois · 96567
Office
$118.23
Facility
Unavailable
$23.25 lower than Madera for the office setting.
Suburban Chicago
Illinois · 96567
Office
$133.00
Facility
Unavailable
$8.48 lower than Madera for the office setting.
Indiana
Indiana · 96567
Office
$119.68
Facility
Unavailable
$21.80 lower than Madera for the office setting.
Kansas
Kansas · 96567
Office
$116.72
Facility
Unavailable
$24.76 lower than Madera for the office setting.
Kentucky
Kentucky · 96567
Office
$114.92
Facility
Unavailable
$26.56 lower than Madera for the office setting.
New Orleans
Louisiana · 96567
Office
$121.70
Facility
Unavailable
$19.78 lower than Madera for the office setting.
Rest Of Louisiana
Louisiana · 96567
Office
$114.42
Facility
Unavailable
$27.06 lower than Madera for the office setting.
Metropolitan Boston
Massachusetts · 96567
Office
$154.24
Facility
Unavailable
$12.76 higher than Madera for the office setting.
Rest Of Massachusetts
Massachusetts · 96567
Office
$136.03
Facility
Unavailable
$5.45 lower than Madera for the office setting.
Baltimore/Surr. Cntys
Maryland · 96567
Office
$138.75
Facility
Unavailable
$2.73 lower than Madera for the office setting.
Rest Of Maryland
Maryland · 96567
Office
$130.78
Facility
Unavailable
$10.70 lower than Madera for the office setting.
Rest Of Maine
Maine · 96567
Office
$118.82
Facility
Unavailable
$22.66 lower than Madera for the office setting.
Southern Maine
Maine · 96567
Office
$127.98
Facility
Unavailable
$13.50 lower than Madera for the office setting.
Detroit
Michigan · 96567
Office
$124.98
Facility
Unavailable
$16.50 lower than Madera for the office setting.
Rest Of Michigan
Michigan · 96567
Office
$118.09
Facility
Unavailable
$23.39 lower than Madera for the office setting.
Minnesota
Minnesota · 96567
Office
$132.77
Facility
Unavailable
$8.71 lower than Madera for the office setting.
Metropolitan Kansas City
Missouri · 96567
Office
$121.39
Facility
Unavailable
$20.09 lower than Madera for the office setting.
Metropolitan St. Louis
Missouri · 96567
Office
$123.07
Facility
Unavailable
$18.41 lower than Madera for the office setting.
Rest Of Missouri
Missouri · 96567
Office
$111.46
Facility
Unavailable
$30.02 lower than Madera for the office setting.
Mississippi
Mississippi · 96567
Office
$111.25
Facility
Unavailable
$30.23 lower than Madera for the office setting.
Montana**
Montana · 96567
Office
$129.26
Facility
Unavailable
$12.22 lower than Madera for the office setting.
North Carolina
North Carolina · 96567
Office
$120.50
Facility
Unavailable
$20.98 lower than Madera for the office setting.
North Dakota**
North Dakota · 96567
Office
$129.06
Facility
Unavailable
$12.42 lower than Madera for the office setting.
Nebraska
Nebraska · 96567
Office
$119.13
Facility
Unavailable
$22.35 lower than Madera for the office setting.
New Hampshire
New Hampshire · 96567
Office
$134.51
Facility
Unavailable
$6.97 lower than Madera for the office setting.
Northern Nj
New Jersey · 96567
Office
$149.91
Facility
Unavailable
$8.43 higher than Madera for the office setting.
Rest Of New Jersey
New Jersey · 96567
Office
$141.16
Facility
Unavailable
$0.32 lower than Madera for the office setting.
New Mexico
New Mexico · 96567
Office
$118.63
Facility
Unavailable
$22.85 lower than Madera for the office setting.
Nevada**
Nevada · 96567
Office
$129.33
Facility
Unavailable
$12.15 lower than Madera for the office setting.
Nyc Suburbs/Long Island
New York · 96567
Office
$153.92
Facility
Unavailable
$12.44 higher than Madera for the office setting.
Poughkpsie/N Nyc Suburbs
New York · 96567
Office
$141.58
Facility
Unavailable
$0.10 higher than Madera for the office setting.
Queens
New York · 96567
Office
$152.87
Facility
Unavailable
$11.39 higher than Madera for the office setting.
Rest Of New York
New York · 96567
Office
$122.72
Facility
Unavailable
$18.76 lower than Madera for the office setting.
Ohio
Ohio · 96567
Office
$118.05
Facility
Unavailable
$23.43 lower than Madera for the office setting.
Oklahoma
Oklahoma · 96567
Office
$115.39
Facility
Unavailable
$26.09 lower than Madera for the office setting.
Portland
Oregon · 96567
Office
$143.49
Facility
Unavailable
$2.01 higher than Madera for the office setting.
Rest Of Oregon
Oregon · 96567
Office
$128.65
Facility
Unavailable
$12.83 lower than Madera for the office setting.
Metropolitan Philadelphia
Pennsylvania · 96567
Office
$134.61
Facility
Unavailable
$6.87 lower than Madera for the office setting.
Rest Of Pennsylvania
Pennsylvania · 96567
Office
$118.67
Facility
Unavailable
$22.81 lower than Madera for the office setting.
Puerto Rico
Puerto Rico · 96567
Office
$130.67
Facility
Unavailable
$10.81 lower than Madera for the office setting.
Rhode Island
Rhode Island · 96567
Office
$133.48
Facility
Unavailable
$8.00 lower than Madera for the office setting.
South Carolina
South Carolina · 96567
Office
$119.41
Facility
Unavailable
$22.07 lower than Madera for the office setting.
South Dakota**
South Dakota · 96567
Office
$129.04
Facility
Unavailable
$12.44 lower than Madera for the office setting.
Tennessee
Tennessee · 96567
Office
$117.37
Facility
Unavailable
$24.11 lower than Madera for the office setting.
Austin
Texas · 96567
Office
$136.70
Facility
Unavailable
$4.78 lower than Madera for the office setting.
Beaumont
Texas · 96567
Office
$117.63
Facility
Unavailable
$23.85 lower than Madera for the office setting.
Brazoria
Texas · 96567
Office
$128.03
Facility
Unavailable
$13.45 lower than Madera for the office setting.
Dallas
Texas · 96567
Office
$128.70
Facility
Unavailable
$12.78 lower than Madera for the office setting.
Fort Worth
Texas · 96567
Office
$127.41
Facility
Unavailable
$14.07 lower than Madera for the office setting.
Galveston
Texas · 96567
Office
$128.30
Facility
Unavailable
$13.18 lower than Madera for the office setting.
Houston
Texas · 96567
Office
$128.48
Facility
Unavailable
$13.00 lower than Madera for the office setting.
Rest Of Texas
Texas · 96567
Office
$122.65
Facility
Unavailable
$18.83 lower than Madera for the office setting.
Utah
Utah · 96567
Office
$121.49
Facility
Unavailable
$19.99 lower than Madera for the office setting.
Virginia
Virginia · 96567
Office
$126.97
Facility
Unavailable
$14.51 lower than Madera for the office setting.
Virgin Islands
United States Virgin Islands · 96567
Office
$130.67
Facility
Unavailable
$10.81 lower than Madera for the office setting.
Vermont
Vermont · 96567
Office
$127.81
Facility
Unavailable
$13.67 lower than Madera for the office setting.
Rest Of Washington
Washington · 96567
Office
$136.01
Facility
Unavailable
$5.47 lower than Madera for the office setting.
Seattle (King Cnty)
Washington · 96567
Office
$158.47
Facility
Unavailable
$16.99 higher than Madera for the office setting.
Wisconsin
Wisconsin · 96567
Office
$123.62
Facility
Unavailable
$17.86 lower than Madera for the office setting.
West Virginia
West Virginia · 96567
Office
$112.52
Facility
Unavailable
$28.96 lower than Madera for the office setting.
Wyoming**
Wyoming · 96567
Office
$129.17
Facility
Unavailable
$12.31 lower than Madera for the office setting.
See how rates vary across the country
96567 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
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 all state and territory rates as a table
| State / territory | 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 |
Where does this rate apply?
Madera is a Medicare payment area. Our Census mapping connects it to 17 cities and communities in California, including the examples shown here.
Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.
Use this rate
What is a percentage of Medicare worth?
Turn a percentage into dollars for 96567 in Madera. This uses the base rate on this page, so the locality and release stay consistent.
Reference amount per service
$155.63
$141.48 × 110% = $155.63
A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.
Working with a whole code list?
Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.
How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 96567 in Madera.
PPRRVU2026_Oct_nonQPP.csv
12,819
- Code
- 96567
- Physician work
- 0.00
- Practice expense
- 3.86
- Malpractice
- 0.01
GPCI2026.csv
14
- Locality
- Madera
- Physician work
- 1.017
- Practice expense
- 1.096
- Malpractice
- 0.536
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.00 | × 1.017 | 0.0000 |
| Practice expense | 3.86 | × 1.096 | 4.2306 |
| Malpractice | 0.01 | × 0.536 | 0.0054 |
| Total RVUs | 4.2359 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Madera$141.48
Open 96567 in the RVU calculator →
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0 | 1.017 |
| Practice expense | 3.86 | 1.096 |
| Malpractice | 0.01 | 0.536 |
(0 × 1.017 + 3.86 × 1.096 + 0.01 × 0.536) × $33.4009 = $141.48
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
How this rate has changed
96567 · Office / nonfacility
$141.48
Effective 2026-10-01
The base rate is $2.00 higher than on 2025-10-01, moving from $139.48 to $141.48 (1.4%).
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
$139.48changed to$141.48
- Conversion factor 32.3465 changed to 33.4009
- Practice expense RVU 3.94 changed to 3.86
- Work GPCI 1.014 changed to 1.017
- Practice expense GPCI 1.093 changed to 1.096
- Malpractice GPCI 0.560 changed to 0.536
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
Earliest loaded release: $139.48
Held through RVU25B, RVU25C, RVU25D.
Explore release dates and calculate this code in an earlier period →
Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.
Inspect every release and its CMS source
| Effective from | Office / nonfacility | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $141.48 | Not available in this setting | RVU26D |
| 2026-07-01 | $141.48 | Not available in this setting | RVU26C |
| 2026-04-01 | $141.48 | Not available in this setting | RVU26B |
| 2026-01-01 | $141.48 | Not available in this setting | RVU26A |
| 2025-10-01 | $139.48 | Not available in this setting | RVU25D |
| 2025-07-01 | $139.48 | Not available in this setting | RVU25C |
| 2025-04-01 | $139.48 | Not available in this setting | RVU25B |
| 2025-01-01 | $139.48 | Not available in this setting | RVU25A |
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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
