Billing code 96574: Lesion debridementMedicare rate & RVUs in Illinois
Reports physician or qualified health care professional debridement of premalignant hyperkeratotic lesions as preparation for photodynamic therapy.
Medicare pays $247.37–$274.42 for 96574 in the office in Illinois, from Rest Of Illinois to Suburban Chicago. Which amount applies depends on the service address.
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 9 sections
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 in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
4 payment localities
$247.37 to $274.42
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | $270.00 | Unavailable |
| East St. Louis | $249.60 | Unavailable |
| Rest Of Illinois | $247.37 | Unavailable |
| Suburban Chicago | $274.42 | Unavailable |
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.
How the rate is built · 96574
RVUs × geographic indexes × conversion factor
Work0.98
0.98 RVUs× 1.000 GPCI
Practice expense6.97
6.97 RVUs× 1.000 GPCI
Malpractice0.04
0.04 RVUs× 1.000 GPCI
Adjusted RVUs
7.9900
Conversion factor
$33.4009
Medicare rate
$266.87
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 96574
The CMS indicators that decide how 96574 is paid alongside other services.
CMS payment indicators · 96574
Lesion debridement
| 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. |
96574 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 96573Photodynamic therapy
- 96573 reports the photodynamic treatment itself by a physician or qualified health care professional; 96574 reports preparatory debridement.
- 96567Photodynamic therapy
- 96567 reports external-light photodynamic treatment of premalignant skin lesions. Use 96574 for the separate preparatory debridement, not for the light treatment.
- 17000Premalignant lesion destruction
- 17000 reports direct destruction of a premalignant lesion. 96574 is for debridement performed to prepare lesions for photodynamic therapy.
96574 billing questions
Does 96574 include the photodynamic treatment itself?
No. It reports preparatory debridement; when a physician or qualified health care professional also performs the photodynamic treatment, report that treatment with 96573.
Is 96574 reported per lesion?
No. It is reported per day, not as a separate unit for each lesion.
Can 96574 be used for debridement unrelated to photodynamic therapy?
No. The debridement must be performed to prepare premalignant hyperkeratotic lesions for photodynamic therapy.
Can modifier 50 be used for treatment on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code; modifier 50 should not be used.
What documentation supports reporting 96574?
Document the premalignant hyperkeratotic lesions, the treated area, and the debridement performed specifically to prepare the lesions for photodynamic therapy.
How does the 0-day global period affect same-day care?
Same-day preoperative and postoperative care is included in the procedure’s payment.
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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