2025 CPT code 96570
Effective Date: N/A Medicine - Photodynamic Therapy Procedures Feed
Photodynamic therapy by endoscopic application of light to ablate abnormal tissue via activation of photosensitive drug(s); first 30 minutes.
Modifier 52 can be used if the service is less than 23 minutes.
Photodynamic therapy is medically necessary for the treatment of certain precancerous and cancerous lesions accessible by endoscopy or bronchoscopy.Medical necessity must be established based on documented evidence of the lesion, including pathology reports, and the appropriateness of PDT as a treatment modality.
The provider administers a photosensitive drug during an endoscopy or bronchoscopy and exposes it to a light source for 30 minutes.The procedure targets and destroys precancerous or cancerous cells in the targeted area.
In simple words: A photosensitizing drug is administered to abnormal tissue, which is then exposed to a specific wavelength of light to destroy the abnormal cells. This procedure is performed during an endoscopy or bronchoscopy and takes approximately 30 minutes.
Photodynamic therapy by endoscopic application of light to ablate abnormal tissue via activation of photosensitive drugs for the initial 30 minutes. This code is used in conjunction with endoscopy or bronchoscopy procedures of the lung and gastrointestinal tract and should be reported separately in addition to the primary procedure code.
Example 1: A patient with Barrett's esophagus undergoes an upper endoscopy (e.g., 43229) with photodynamic therapy (96570) for ablation of the abnormal esophageal tissue during the initial 30 minutes of PDT application., A patient with early-stage lung cancer undergoes a bronchoscopy (e.g., 31641) with photodynamic therapy (96570) administered via the bronchoscope for 30 minutes to destroy the tumor., A patient with high-grade dysplasia in the colon undergoes a colonoscopy with photodynamic therapy (96570) to eliminate the abnormal tissue.
Documentation should include the type of endoscopy or bronchoscopy performed, the site and size of the lesion(s) treated, the type of photosensitizing drug used, the light source used, and the duration of light exposure.The medical necessity of the procedure should be clearly documented.
** This code is for the first 30 minutes of photodynamic therapy. For each additional 15 minutes, report code 96571.
- RVU: 1.52 RVU
- Specialties:Gastroenterology, Pulmonology, Oncology, Surgery
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center