CPT 96567 Other

How Much Does Pdt Dstr Prmlg Les Skn Cost?

Also known as: Pdt dstr prmlg les skn (CPT 96567)

Photodynamic therapy (PDT) using light-activated medication to treat pre-cancerous skin lesions.

Pdt Dstr Prmlg Les Skn (CPT 96567) costs $129 at Medicare rates.

Medicare (Facility)
$129
CMS PFS 2026 national rate

Patient Guide: Pdt Dstr Prmlg Les Skn

What you need to know before your appointment

What to Expect

A light-sensitizing cream is applied to the skin and left for 1-3 hours. Then a special light is directed at the treated area to activate the medication and destroy abnormal cells.

How Long Does It Take?

30 minutes of light exposure (plus 1-3 hours of medication incubation)

Common Reasons Doctors Order This

Multiple actinic keratoses, field treatment of sun-damaged skin, superficial skin cancers

How to Prepare

Avoid sun exposure for 48 hours after treatment. The treated skin will become red, swollen, and may blister. This is expected. Apply gentle skin care as directed.

Procedures Commonly Done Together

These procedures are frequently performed alongside Pdt dstr prmlg les skn

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How to Reduce Your Cost for Pdt dstr prmlg les skn

Practical tips that can save you hundreds or thousands of dollars

  • 1
    Ask about cash-pay discounts

    Many hospitals and clinics offer 20-40% discounts for self-pay patients. Always ask before scheduling.

  • 2
    Compare facility vs. office setting costs

    Some procedures cost significantly less in an office setting than a hospital. Ask your provider about options.

  • 3
    Shop around — costs vary significantly

    Costs can vary 2-3x between providers in the same city. Get quotes from multiple facilities.

Frequently Asked Questions

How much does Pdt dstr prmlg les skn cost?

The Medicare facility rate for Pdt dstr prmlg les skn is $129. Commercial insurance rates typically range from 150% to 250% of Medicare (varies by plan).

How much does Pdt dstr prmlg les skn cost without insurance?

Without insurance, the cost of Pdt dstr prmlg les skn can range from 150% of Medicare to 500% of Medicare depending on the facility. Many hospitals and clinics offer self-pay discounts of 20-40% off their chargemaster price. Always ask about cash pricing before your visit.

Does insurance cover Pdt dstr prmlg les skn?

Most commercial health insurance plans and Medicare cover Pdt dstr prmlg les skn when ordered by a physician for a medically necessary reason. Your out-of-pocket cost depends on your plan's deductible, copay/coinsurance structure, and whether you use an in-network provider. Check with your insurance company before scheduling to confirm coverage and get a cost estimate.

Why does the cost vary so much by location?

Medicare adjusts payments using Geographic Practice Cost Indices (GPCIs) that reflect local differences in physician work costs, practice expenses, and malpractice insurance. Manhattan, San Francisco, and other high-cost areas pay significantly more than rural regions. Commercial insurers follow similar geographic patterns.

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