Billing code 96573: Photodynamic therapyMedicare rate & RVUs in Ohio
Reports physician- or QHP-performed photodynamic treatment of premalignant skin or adjacent mucosal lesions, including application of photosensitizing agent when performed.
Medicare pays $199.95 for 96573 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 96573 covers
Code 96573 describes photodynamic treatment of premalignant lesions of the skin or adjacent mucosa using an applied photosensitizer and external light. Dermatologists commonly use it for actinic keratoses, such as lesions on the face or scalp. A physician or other qualified health care professional performs the service in an office or outpatient setting; the code includes application of the photosensitizing agent when performed.
Report the service per treatment day, rather than per lesion or light-treatment interval. Documentation should identify the treated sites, the photosensitizer application when performed, and the light treatment. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. Modifier 50 is inappropriate for this service. Assistant-at-surgery payment requires documentation of 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.
96573 in Ohio
| Payment locality | Office | Facility |
|---|---|---|
| Ohio | $199.95 | Unavailable |
How the 96573 rate is calculated
Each of 96573’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 · 96573
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.47Practice expense 6.02Malpractice 0.02
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 96573
The CMS indicators that decide how 96573 is paid alongside other services.
CMS payment indicators · 96573
Photodynamic therapy
| 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. |
96573 compared with similar codes
Compare codes
96573 vs 96567 vs 96574 vs 17000: national Medicare rates
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How to choose
- 96567Photodynamic therapy
- Use 96573 when the service includes application of the photosensitizing agent. Code 96567 represents photodynamic treatment without that included agent-application element.
- 96574Lesion debridement
- Code 96574 describes photodynamic treatment that also includes debridement of premalignant lesions; 96573 does not describe that debridement service.
- 17000Premalignant lesion destruction
- Code 17000 is for cryosurgical destruction of a first premalignant lesion. Code 96573 is photodynamic treatment using a photosensitizer and external light.
96573 billing questions
How does 96573 differ from 96567?
Code 96573 includes application of the photosensitizing agent when performed. Code 96567 describes photodynamic treatment without that included agent-application element.
Is 96573 reported for each lesion?
No. It is reported per treatment day, not per lesion or light-treatment interval.
Can the photosensitizing drug be billed separately?
The drug may be separately reportable when supplied and applicable. For topical aminolevulinic acid, J7308 is a related drug code.
Should modifier 50 be used for lesions on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this service; report the treatment day rather than separate right- and left-side services.
What same-day care is included in the global period?
The 0-day global period includes same-day preoperative and postoperative care. The code is reported for the photodynamic treatment itself.
When can an assistant-at-surgery be paid?
Only when documentation establishes medical necessity. Co-surgeons and team surgery are not permitted.
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
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