CPT 93797 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 • Cardiovascular Procedures |
| Common Place of Service | • 11 - Office • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • XU - Unusual Non-Overlapping Service |
| Complexity Level | Moderate |
National average reimbursement for CPT 93797 by major payers:
$21.48
$21.84
$22.16
$27.71
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
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CPT 93797 vs. Other Cardiovascular Procedures Codes
The CPT 93797 code is part of the Medicine Services and Procedures services used for Cardiovascular 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 93797 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 |
|---|---|---|
| 93792 | Low | Patient/Caregiver Training For Initiation Of Home International Normalized Ratio (Inr) Monitoring Under The Direction Of A Physician Or Other Qualified Health Care Professional Face-To-Face Includingu00a0use And Care Of The Inr Monitor Obtaining Blood Sample Instructions For Reportinghome Inr Test Results And Documentation Of Patients/Caregiver-S Ability To Perform Testing And Report Results |
| 93793 | Low | Anticoagulant Management For A Patient Taking Warfarin Must Include Review And Interpretation Of A New Home Office Or Lab International Normalized Ratio (Inr) Test Result Patient Instructions Dosage Adjustment (As Needed) And Scheduling Of Additional Test(S) When Performed |
| 93797 | Low | Physician Or Other Qualified Health Care Professional Services For Outpatient Cardiac Rehabilitation; Without Continuous Ecg Monitoring (Per Session) (Revised 01/01/13) |
| 93798 | Low | Physician Or Other Qualified Health Care Professional Services For Outpatient Cardiac Rehabilitation; With Continuous Ecg Monitoring (Per Session) (Revised 01/01/13) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 93797. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 93797 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.
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Medicare Reimbursement Lookup Tool
Medicare localities are geographic regions used to adjust reimbursement rates based on local costs. Rates vary by locality to reflect differences in wages, rent, and other expenses. Sign up to see commercial rates (United/BCBS/Cigna/Aetna)
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| Year | Billing Code | Locality | Non-Facility Fee | Facility Fee |
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