$195.06
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 Photodynamic therapy Medicare reimbursement rates in Kentucky
Reports an external-light photodynamic treatment using a photosensitizing agent to destroy premalignant lesions of the skin or adjacent mucosa. Compare 96567 office and facility rates across CMS payment localities in Kentucky.
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 96567 in Kentucky?
Kentucky 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
$114.92
1 of 1 localities have a supported rate.
Payment area: Kentucky
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 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 Kentucky, from the same CMS release.
$240.92
96574 describes debridement that prepares premalignant lesions for photodynamic therapy, not the photosensitizer-and-light treatment itself.
$61.33
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.
Compare 96567 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
Kentucky →
Office / nonfacility
$114.92
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 96567 in Kentucky.
PPRRVU2026_Oct_nonQPP.csv
12,819
- Code
- 96567
- Physician work
- 0.00
- Practice expense
- 3.86
- Malpractice
- 0.01
GPCI2026.csv
55
- Locality
- Kentucky
- Physician work
- 1.000
- Practice expense
- 0.889
- Malpractice
- 0.915
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.00 | × 1.000 | 0.0000 |
| Practice expense | 3.86 | × 0.889 | 3.4315 |
| Malpractice | 0.01 | × 0.915 | 0.0092 |
| Total RVUs | 3.4407 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Kentucky$114.92
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0 | 1 |
| Practice expense | 3.86 | 0.889 |
| Malpractice | 0.01 | 0.915 |
(0 × 1 + 3.86 × 0.889 + 0.01 × 0.915) × $33.4009 = $114.92
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.
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.
12,81696547,,Intraop hipec px 1st 60 min,A,,6.53,1.82,NA,1.82,,1.52,9.87,9.87,0,ZZZ,0.00,0.00,0.00,0,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,81796548,,Ntraop hipec px ea add 30min,A,,3.00,0.85,NA,0.85,,0.69,4.54,4.54,0,ZZZ,0.00,0.00,0.00,0,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,81896549,,Unlisted chemotherapy px,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,81996567,,Pdt dstr prmlg les skn,A,,0.00,3.86,,3.86,NA,0.01,3.87,3.87,5,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,82096570,,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
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
5707202,LA,99,REST OF LOUISIANA,1.000,0.885,0.958
5814112,ME,03,SOUTHERN MAINE,1.000,0.991,0.631