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See a sample rate comparisonCPT 97010 Fee Schedule
Last Verified: October 2026
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.
Application Of A Modality To O, Application Of A Modality To One Or More Areas Hot Or Cold Packs Application Of A Modality To One Or More Areas Hot Or Cold
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Physical Medicine and Rehabilitation Evaluations |
| Common Place of Service | 11 - Office 49 - Independent Clinic |
| Common Modifiers | GP - Services delivered under an outpatient physical therapy plan of care CQ - PT services by assistant |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 97010 |
| Medicaid Fee Schedule | $6.71 median of the 8 states in the free preview · View Medicaid rates for 97010 |
National average reimbursement for CPT 97010 by major payers:
$13.68
$6.26
$6.85
$6.95
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CPT 97010
5 of 25 sample ratesHigher to lower in this preview
Colin Geldart
Inova Health Care Services
$8.26Published rateEthan Sherman
Orthovirginia, Inc.
$7.57Published rateBrian Dorius
Orthovirginia, Inc.
$6.44Published rateCharlesetta Morris
Cape Fear Orthopaedic Clinic, P.A.
$5.82Published rateLauren Shouldis
Norfolk Foot & Ankle Group, P.C.
$3.52Published rate
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See a sample payer proposalCPT 97010 vs. Other Physical Medicine and Rehabilitation Evaluations Codes
The CPT 97010 code is part of the Medicine Services and Procedures services used for Physical Medicine and Rehabilitation Evaluations. 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 97010 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 |
|---|---|---|
| 96999-CPT | Moderate | Unlisted Special Dermatological Svc Or Proc, Unlisted Special Dermatological Service Or Procedure |
| 97010-CPT | Low | Application Of A Modality To O, Application Of A Modality To One Or More Areas Hot Or Cold Packs Application Of A Modality To One Or More Areas Hot Or Cold |
| 97012-CPT | Low | Application Of A Modality To O, Application Of A Modality To One Or More Areas Tractionmechanical Application Of A Modality To One Or More Areas Traction |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 97010. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 97010 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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Frequently Asked Questions
CPT 97010 is a Physical Medicine and Rehabilitation Evaluation code representing a moderate-complexity encounter within Medicine Services and Procedures. It distinguishes itself from other evaluation codes primarily by requiring more provider time and involving a moderate level of medical decision-making, unlike lower-level codes that demand less time and simpler assessments. Encounters billed under 97010 typically include multiple diagnoses, medication management, or test interpretation, which leads to higher reimbursement and more detailed documentation requirements compared to less complex evaluation codes. For specific details on reimbursement rates or comparisons for CPT 97010 in your particular location, you can utilize Payerprice's fee schedule lookup tool.