$199.95
96573 reports the photodynamic treatment itself by a physician or qualified health care professional; 96574 reports preparatory debridement.
On this page
CMS RVU26D · Effective 2026-10-01
96574 Lesion debridement Medicare reimbursement rates in Iowa
Reports physician or qualified health care professional debridement of premalignant hyperkeratotic lesions as preparation for photodynamic therapy. Compare 96574 office and facility rates across CMS payment localities in Iowa.
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.
What does Medicare pay for 96574 in Iowa?
Iowa has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$246.28
1 of 1 localities have a supported rate.
Payment area: Iowa
One mapped payment locality.
Facility setting
No supported rate
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Dermatology procedure
About 96574: Premalignant lesion debridement for photodynamic therapy
Reports physician or qualified health care professional debridement of premalignant hyperkeratotic lesions as preparation for photodynamic therapy.
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.
CMS billing rules for 96574
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is included.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU0.98 · 12%
- Practice expense (office) RVU6.97 · 87%
- Malpractice RVU0.04 · 1%
69.6K
Medicare services in 2024 · #675 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.
96574 compared with similar codes
Office rates for Iowa, from the same CMS release.
$118.10
96567 reports external-light photodynamic treatment of premalignant skin lesions. Use 96574 for the separate preparatory debridement, not for the light treatment.
$61.45
17000 reports direct destruction of a premalignant lesion. 96574 is for debridement performed to prepare lesions for photodynamic therapy.
Compare 96574 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Iowa →
Office / nonfacility
$246.28
Facility
Unavailable
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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 96574 in Iowa.
PPRRVU2026_Oct_nonQPP.csv
12,823
- Code
- 96574
- Physician work
- 0.98
- Practice expense
- 6.97
- Malpractice
- 0.04
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.98 | × 1.000 | 0.9800 |
| Practice expense | 6.97 | × 0.915 | 6.3776 |
| Malpractice | 0.04 | × 0.397 | 0.0159 |
| Total RVUs | 7.3734 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Iowa$246.28
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.98 | 1 |
| Practice expense | 6.97 | 0.915 |
| Malpractice | 0.04 | 0.397 |
(0.98 × 1 + 6.97 × 0.915 + 0.04 × 0.397) × $33.4009 = $246.28
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.
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 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.
12,82096570,,Photodynmc tx 30 min add-on,A,,1.10,0.39,,0.20,,0.08,1.57,1.38,0,ZZZ,0.00,0.00,0.00,0,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,82196571,,Photodynamic tx addl 15 min,A,,0.55,0.20,,0.10,,0.05,0.80,0.70,0,ZZZ,0.00,0.00,0.00,0,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,82296573,,Pdt dstr prmlg les phys/qhp,A,,0.47,6.02,,6.02,NA,0.02,6.51,6.51,0,000,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,82396574,,Dbrdmt prmlg les w/pdt,A,,0.98,6.97,,6.97,NA,0.04,7.99,7.99,0,000,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,82496900,,Actinotherapy uv light,A,,0.00,0.70,,0.70,NA,0.01,0.71,0.71,5,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,82596902,,Mcrscp xm hair pluck/clipped,B,+,0.40,0.24,,0.09,,0.02,0.66,0.51,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
12,82696904,,Whole body photography,R,,0.00,1.97,,1.97,NA,0.01,1.98,1.98,5,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136