2025 CPT code 96571
(Active) Effective Date: N/A Therapeutic Procedures - Photodynamic Therapy Procedures Medicine Feed
Photodynamic therapy by endoscopic application of light to ablate abnormal tissue via activation of photosensitive drug(s); each additional 15 minutes (List separately in addition to code for endoscopy or bronchoscopy procedures of lung and gastrointestinal tract).
Modifiers may be applicable to 96571, for example modifier 52 may be reported if the service time for the 15 minute interval is less, 78 if there was a return to the OR, and 59 if the service constitutes a distinct procedural service.
Medical necessity for PDT must be supported by documentation indicating the presence of abnormal tissue requiring treatment and why PDT is an appropriate therapeutic approach.
The physician administers a photosensitizing drug to the abnormal tissue during the endoscopy or bronchoscopy. After the initial 30-minute application, they administer and expose it to light for each additional 15 minutes (up to 38-52 minutes) for the oxygen to destroy the targeted cells effectively.
In simple words: This code covers the extra time needed for a special light treatment during an endoscopy or bronchoscopy. After the first 30 minutes, every 15-minute period is billed using this code, up to a total treatment time of 52 minutes. The treatment uses a drug and light to destroy abnormal cells.
This code reports each additional 15 minutes of photodynamic therapy (PDT) administered endoscopically, beyond the initial 30 minutes. PDT involves using a photosensitive drug and light to destroy abnormal tissues. The photosensitive drug is applied, and then an endoscopic light source activates it, producing a form of oxygen that destroys abnormal cells. This code is used as an add-on to the primary endoscopy or bronchoscopy procedure code and the initial 30 minutes of PDT (96570). For the first 30 minutes of PDT, use 96570. For 38-52 minutes, use 96570 with +96571.
Example 1: A patient undergoing a bronchoscopy for suspected lung cancer has PDT performed for 45 minutes to target precancerous cells in the bronchial lining. 96570 is reported for the initial 30 minutes, and 96571 is reported once for the additional 15 minutes., A patient with Barrett's esophagus undergoes an esophagoscopy and has 38 minutes of PDT to destroy abnormal cells. 96570 is reported for the first 30 minutes, and 96571 is reported once for the additional 8 minutes (rounded to a 15-minute interval.), A patient has a colonoscopy with PDT for a total of 52 minutes. The appropriate endoscopy code, along with 96570 and 96571 (x2) would be reported.
Documentation should include details of the primary procedure (endoscopy or bronchoscopy), the area treated with PDT, the type of photosensitizing drug used, the light source utilized, and the total duration of the PDT treatment.
** It's crucial to round up to the nearest 15-minute interval after the initial 30 minutes. For example, if the treatment lasted 38 minutes, 96571 would be reported once. If the service lasted for 50 minutes, it would be reported twice (30min+15min+5min≈30+30).
- Payment Status: Active
- Specialties:Pulmonology, Gastroenterology, Oncology, General Surgery
- Place of Service:Ambulatory Surgical CenterOutpatient HospitalInpatient Hospital