Billing code 96570: Photodynamic therapyMedicare rate & RVUs in Ohio
Reports an additional 30-minute increment of photodynamic therapy, billed with the related primary procedure when treatment time exceeds its initial service.
Medicare pays $51.33 for 96570 in the office in Ohio (Ohio). 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 96570 covers
This add-on represents additional time spent delivering photodynamic therapy after the primary service’s initial treatment period. The therapy uses light to activate a photosensitive drug and treat abnormal tissue; the endoscopic approach is used to reach internal sites, such as an esophageal lesion. A physician or other qualified clinician may perform the treatment in a hospital or other procedural setting.
Report 96570 only with its related primary photodynamic therapy procedure, such as 96569, when the documented treatment extends into an additional 30-minute increment. The record should identify the treatment performed and support the additional time beyond the primary service. CMS classifies this as an add-on code, so it is paid within the primary procedure’s global period.
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.
96570 in Ohio
| Payment locality | Office | Facility |
|---|---|---|
| Ohio | $51.33 | $45.53 |
How the 96570 rate is calculated
Each of 96570’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 · 96570
RVUs × geographic indexes × conversion factor
Work1.10
1.10 RVUs× 1.000 GPCI
Practice expense0.39
0.39 RVUs× 1.000 GPCI
Malpractice0.08
0.08 RVUs× 1.000 GPCI
Adjusted RVUs
1.5700
Conversion factor
$33.4009
Medicare rate
$52.44
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 96570
The CMS indicators that decide how 96570 is paid alongside other services.
CMS payment indicators · 96570
Photodynamic therapy
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| 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) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
96570 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 96571Endoscopic photodynamic therapy
- Both describe additional photodynamic therapy time, but 96570 is the 30-minute add-on and 96571 is the 15-minute add-on.
- 96567Photodynamic therapy
- 96567 describes external-light treatment of premalignant skin lesions; 96570 reports additional time with a primary photodynamic therapy procedure.
- 96573Photodynamic therapy
- 96573 describes the physician or qualified health professional service for external-light treatment of premalignant lesions, not an additional 30-minute increment.
96570 billing questions
When should 96570 be reported?
Report it for an additional 30-minute increment of photodynamic therapy beyond the primary procedure’s initial treatment period. It cannot be reported by itself.
Which primary procedure is paired with 96570?
It is paired with the related primary photodynamic therapy service, such as 96569. The documentation should support the primary treatment and the additional time.
How is 96570 different from 96571?
The CMS short descriptors distinguish the additional time increments: 96570 represents a 30-minute add-on, while 96571 represents an additional 15-minute increment.
What documentation supports an additional unit?
Document the photodynamic treatment and the time spent delivering it, showing that the additional 30-minute increment is supported beyond the primary service.
Is 96570 paid separately from the primary procedure’s global period?
No. CMS identifies 96570 as an add-on paid within the primary procedure’s global period.
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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