$26.12–$29.09
Both describe additional photodynamic therapy time, but 96570 is the 30-minute add-on and 96571 is the 15-minute add-on.
On this page
CMS RVU26D · Effective 2026-10-01
96570 Photodynamic therapy Medicare reimbursement rates in Virginia
Reports an additional 30-minute increment of photodynamic therapy, billed with the related primary procedure when treatment time exceeds its initial service. Compare 96570 office and facility rates across CMS payment localities in Virginia.
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 96570 in Virginia?
Virginia has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$51.43–$57.04
2 of 2 localities have a supported rate.
Facility setting
$45.19–$49.57
2 of 2 localities have a 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.
Photodynamic therapy
About 96570: Additional photodynamic therapy time
Reports an additional 30-minute increment of photodynamic therapy, billed with the related primary procedure when treatment time exceeds its initial service.
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.
CMS billing rules for 96570
- Global period
- Add-on code: billed only together with a primary procedure and paid within that procedure's global period.
Where the value comes from
- Work RVU1.10 · 70%
- Practice expense (office) RVU0.39 · 25%
- Malpractice RVU0.08 · 5%
84
Medicare services in 2024 · #5010 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.
96570 compared with similar codes
Office rates for Virginia, from the same CMS release.
$126.97–$152.25
96567 describes external-light treatment of premalignant skin lesions; 96570 reports additional time with a primary photodynamic therapy procedure.
$213.83–$254.15
96573 describes the physician or qualified health professional service for external-light treatment of premalignant lesions, not an additional 30-minute increment.
Compare 96570 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.
2 of 2 payment localities
Dc + Md/Va Suburbs →
Office / nonfacility
$57.04
Facility
$49.57
Virginia →
Office / nonfacility
$51.43
Facility
$45.19
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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 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.
12,81796548,,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
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