CPT Code 96574: Photodynamic Therapy for Actinic Keratosis, Face/Scalp

Learn how CPT 96574 covers physician-performed photodynamic therapy to destroy premalignant skin lesions using topical drugs and light activation.

Use Code

What is photodynamic therapy (PDT)?

CPT 96574 is a Current Procedural Terminology (CPT) code used to report photodynamic therapy (PDT) procedures involving the topical administration of a photosensitizing drug—typically aminolevulinic acid (e.g., Levulan, J7308)—to treat premalignant lesions such as actinic keratoses (AKs). This code specifically applies when the procedure is performed by a physician or other qualified health care professional on the skin and adjacent mucosa, most often the face and scalp.

The treatment involves the application of the photosensitive drug, followed by an incubation period, and then activation with light to destroy premalignant lesions. This photodynamic therapy by external application serves as an effective treatment modality for field cancerization and widespread dysplastic lesions, offering a non-invasive alternative to laser therapies, cryosurgery, or topical agents.

This is a new CPT code designed to distinguish physician-performed PDT from similar services performed by other qualified health care personnel (reported with CPT 96573).

As a new code introduced to better define PDT procedures, CPT 96574 highlights the physician's direct role in the activation of the photosensitive drug. The process involves the illumination activation of the photosensitizing agent after the incubation phase. Proper coding requires documentation of the activation of the photosensitizing drug and the anatomic location treated, ensuring that all steps—from topical administration to final illumination—are clearly recorded and supported.

CPT code 96574 documentation requirements

When billing for CPT code 96574, ensure the medical record includes the following:

Diagnosis of actinic keratosis or other premalignant conditions treated
Name of the photosensitizing drug used (e.g., Levulan)
Details of topical administration: application site, duration of incubation
Type of light source used to activate the drug
Anatomic site(s) treated, including distinction between areas if multiple sites are involved
Patient response, tolerance, and post-procedure instructions

These details support the medical necessity and ensure compliance with CPT guidelines and payer policies.

CPT code 96574 billing guidelines

When reporting CPT 96574, follow these billing rules:

This code is reported per session when photodynamic therapy procedures are performed by a physician or qualified health care professional.
Do not report 96573 (PDT by non-physician staff) for the same anatomical area as 96574 on the same date of service.
The photosensitizing drug (e.g., J7308) is not bundled and must be billed separately.
Typically reported for the face and scalp as a single anatomical region.
CPT 96574 may carry specific relative value units (RVUs) and Medicare coverage limits, so confirm with the payer.

Other relevant CPT codes

96573: PDT for premalignant skin lesions performed by other qualified health care professionals (non-physicians)
J7308: Supply of aminolevulinic acid HCl (Levulan Kerastick)
Other procedure codes may apply if additional services like biopsy or lesion removal are performed on separate sites

Frequently asked questions

The American Medical Association (AMA) outlines in the revised Current Procedural Terminology that activation of a photosensitizing drug—such as aminolevulinic acid—occurs through the external application of light. This illumination must be part of a complete application and illumination activation cycle, which is directly involved in targeting and destroying premalignant hyperkeratotic lesions.

Yes, PDT treatment can be paired with targeted curettage, particularly when treating cutaneous lesions that are thickened or scaly, such as premalignant hyperkeratotic lesions. However, both services must be medically necessary, and if separately reportable, must be performed on distinct lesions or anatomical areas. The qualified healthcare professional must clearly document that curettage and photodynamic therapy were provided as separate and distinct services to ensure accurate billing.

While documentation of the entire tube isn’t always required, it is essential to specify the dose applied, site of application, and the illumination activation method used. The therapeutic approach must be documented in detail, especially when multiple lesions of the skin or adjacent mucosa are treated. The vast majority of payer policies also require clear notation that a qualified healthcare professional performed or directly supervised the application and illumination activation steps.