CPT 90997 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Medicine Services and Procedures • Dialysis Services and Procedures |
| Common Place of Service | • 21 - Inpatient Hospital • 11 - Office |
| Common Modifiers | • None • G5 - Most recent URR reading of 75 or greater • V7 - Arteriovenous fistula • SE - Scene to Residential facility • SL |
| Complexity Level | Low |
National average reimbursement for CPT 90997 by major payers:
$126.11
$118.23
$108.59
$144.22
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 90997 | ||||||
United | 90997 | $80.48 | 1194430504 - JULIA LOZA-VEGA | 541383504 - TOWN CENTER ORTHOPAEDIC ASSOCIATES, P.C. | VA | Physician Assistant (363A00000X) |
United | 90997 | $189.80 | 1982268959 - SIDRAH NAJAM | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IN | Psychiatry Physician (2084P0800X) |
United | 90997 | $178.16 | 1154749844 - NORA EKEANYA | 910844563 | CA | Psychiatry Physician (2084P0800X) |
United | 90997 | $219.92 | 1063471159 - MARK WAINWRIGHT | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | WA | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90997 | $125.65 | 1225211600 - JOHN MILLICHAP | 841343242 | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90997 | $175.96 | 1962664789 - JAMIE EVANS | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | VA | Psychiatry Physician (2084P0800X) |
United | 90997 | $127.35 | 1255478004 - CHRISTOPHER RAIO | 208243412 - SAMARITAN EMERGENCY MEDICAL SERVICES PC | NY | Emergency Medicine Physician (207P00000X) |
United | 90997 | $138.58 | 1295736726 - MOHAMED KATERJI | 364473799 - (IL) KATERJI PEDIATRIC NEUROLOGY ASSOC | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90997 | $99.59 | 1689716953 - OFELIA IONESCU | 421583192 - (IL) OFELIA MARTHA IONESCU LTD | IL | Psychiatry Physician (2084P0800X) |
United | 90997 | $186.08 | 1952795254 - MALCOLM VANDREVALA | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 90997 | $113.80 | 1861488132 - JYOTI WARIKOO | 363305449 - (IL) MOUNT SINAI COMMUNITY FOUNDATION | IL | Psychiatry Physician (2084P0800X) |
United | 90997 | $152.58 | 1083979124 - RAHUL SHARMA | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 90997 | $321.30 | 1225211600 - JOHN MILLICHAP | 800863895 | CO | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90997 | $114.33 | 1578097846 - CHRISTOPHER LOMBARDI | 933237501 | TN | Psychiatry Physician (2084P0800X) |
United | 90997 | $285.30 | 1386969079 - ADAM WALLACE | 391678306 - AURORA MEDICAL GROUP INC | WI | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
CPT 90997 vs. Other Dialysis Services and Procedures Codes
The CPT 90997 code is part of the Medicine Services and Procedures services used for Dialysis Services and Procedures. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 90997 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 90935-CPT | Low | Hemodialysis Procedure With Single Evaluation By Physician Or Other Qualified Health Care Professional (Revised 1/1/2013) |
| 90937-CPT | Low | Hemodialysis Procedure Requiring Repeated Evaluation(S) With Or Without Substantial Revision Of Dialysis Prescript |
| 90989-CPT | Moderate | Dialysis Trng, Pt, Helper, Any Mode, Com |
| 90997-CPT | Low | Hemoperfusion |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 90997. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 90997 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 90997) and we'll show you how you compare in 15 minutes or less.