$133.48
Use 96573 when the service includes application of the photosensitizing agent. Code 96567 represents photodynamic treatment without that included agent-application element.
On this page
CMS RVU26D · Effective 2026-10-01
96573 Photodynamic therapy Medicare reimbursement rates in Rhode Island
Reports physician- or QHP-performed photodynamic treatment of premalignant skin or adjacent mucosal lesions, including application of photosensitizing agent when performed. Compare 96573 office and facility rates across CMS payment localities in Rhode Island.
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 96573 in Rhode Island?
Rhode Island 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
$224.30
1 of 1 localities have a supported rate.
Payment area: Rhode Island
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 96573: Photodynamic therapy with agent application
Reports physician- or QHP-performed photodynamic treatment of premalignant skin or adjacent mucosal lesions, including application of photosensitizing agent when performed.
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.
CMS billing rules for 96573
- 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 RVU0.47 · 7%
- Practice expense (office) RVU6.02 · 92%
- Malpractice RVU0.02 · 0%
32.6K
Medicare services in 2024 · #941 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.
96573 compared with similar codes
Office rates for Rhode Island, from the same CMS release.
$275.03
Code 96574 describes photodynamic treatment that also includes debridement of premalignant lesions; 96573 does not describe that debridement service.
$68.10
Code 17000 is for cryosurgical destruction of a first premalignant lesion. Code 96573 is photodynamic treatment using a photosensitizer and external light.
Compare 96573 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
Rhode Island →
Office / nonfacility
$224.30
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 96573 in Rhode Island.
PPRRVU2026_Oct_nonQPP.csv
12,822
- Code
- 96573
- Physician work
- 0.47
- Practice expense
- 6.02
- Malpractice
- 0.02
GPCI2026.csv
92
- Locality
- Rhode Island
- Physician work
- 1.019
- Practice expense
- 1.033
- Malpractice
- 0.892
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.47 | × 1.019 | 0.4789 |
| Practice expense | 6.02 | × 1.033 | 6.2187 |
| Malpractice | 0.02 | × 0.892 | 0.0178 |
| Total RVUs | 6.7154 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Rhode Island$224.30
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.47 | 1.019 |
| Practice expense | 6.02 | 1.033 |
| Malpractice | 0.02 | 0.892 |
(0.47 × 1.019 + 6.02 × 1.033 + 0.02 × 0.892) × $33.4009 = $224.30
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.
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 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.
12,81996567,,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
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
8912502,PA,01,METROPOLITAN PHILADELPHIA,1.018,1.041,1.193
9012502,PA,99,REST OF PENNSYLVANIA,1.000,0.918,0.945
9109202,PR,20,PUERTO RICO,1.000,1.011,0.985
9214412,RI,01,RHODE ISLAND,1.019,1.033,0.892
9311202,SC,01,SOUTH CAROLINA,1.000,0.924,0.850
9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336
9510312,TN,35,TENNESSEE,1.000,0.909,0.537