CPT 96567: Photodynamic Therapy for Precancerous Skin Lesions
CPT code 96567 designates photodynamic therapy where a photosensitizing agent is applied to a skin lesion and activated by a specific wavelength of light to destroy precancerous cells. This procedure is typically performed for actinic keratoses and certain in-situ skin neoplasms and is reportable once per day regardless of the number of applications. Nationally, photodynamic therapy represents a targeted, minimally invasive dermatologic option that can reduce progression to invasive disease for selected lesions.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for use of CPT code 96567, common settings where the service is performed, and practical coding details relevant to billing cycles. The publication also highlights related procedure coding for clinicians and billing teams and summarizes payer coverage considerations and coding frequency rules.
Intended takeaways include: a clear definition of the service represented by CPT code 96567, the typical clinical indications and sites of service, and the coding rule that the code is reported once per day. Data not available in the input include payer-specific reimbursement rates and individual policy coverage criteria.
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Billing Code Overview
CPT code 96567 describes a photodynamic therapy procedure in which a provider applies a photosensitizing drug to a lesion and exposes the area to a specific wavelength of light to destroy precancerous cells. The technique is selected based on the depth of tissue penetration required and is intended to treat localized precancerous or in-situ skin lesions.
Service Type: Photodynamic therapy (topical photosensitizer with light activation)
Typical Site of Service: Office-based dermatology clinic or outpatient procedural suite
National Reimbursement Benchmarks
National averages place Blue Cross Blue Shield and other commercial groups above Medicare for CPT 96567: BUCA’s mean is $296.90 versus Medicare’s mean of $135.50, so BUCA averages $161.40 higher than Medicare. This gap highlights a meaningful premium in commercial negotiated rates compared with the federal program.
Dispersion across payers varies notably. Blue Cross Blue Shield shows one of the widest interquartile spreads (P75–P25 = $297.50), and BUCA’s spread is $226.80, indicating substantial variability among commercial contracts. UnitedHealth Group (spread = $131.40) and Cigna (spread = $148.90) are intermediate, while Aetna is the tightest by this measure (spread = $89.00). Medicare’s IQR is narrow at $20.00 across its localities, reflecting relatively consistent rates.