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See a sample rate comparisonCPT 97028 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 Ultraviolet Application Of A Modality To One Or Moreareas Ultraviolet
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Physical Medicine and Rehabilitation Evaluations |
| Common Place of Service | 11 - Office |
| Common Modifiers | GP - Services delivered under an outpatient physical therapy plan of care 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | $8.35 national non-facility rate (2026) · View Medicare rates for 97028 |
| Medicaid Fee Schedule | $7.52 median of the 7 states in the free preview · View Medicaid rates for 97028 |
National average reimbursement for CPT 97028 by major payers:
$17.36
$7.95
$8.86
$8.75
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CPT 97028
5 of 25 sample ratesHigher to lower in this preview
David Hsu
Aurora Medical Group Inc
$27.29Published rateRolando Henriquez
Progressive Medical Center, S.C.
$8.86Published rateAnita Pairitz
Loyola University Medical Center
$8.21Published rateMy Phon Nguyen
Mount Sinai Community Foundation
$7.51Published rateJocelyn Lorenzo
$4.98Published rate
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See a sample payer proposalCPT 97028 vs. Other Physical Medicine and Rehabilitation Evaluations Codes
The CPT 97028 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 97028 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 |
|---|---|---|
| 97026-CPT | Low | Application Of A Modality To O, Application Of A Modality To One Or More Areas Infraredapplication Of A Modality To One Or More Areas Infrared |
| 97028-CPT | Low | Application Of A Modality To O, Application Of A Modality To One Or More Areas Ultraviolet Application Of A Modality To One Or Moreareas Ultraviolet |
| 97032-CPT | Low | Application Of A Modality To O, Application Of A Modality To One Or More Areas Electricalstimulation(Manual) Each 15 Minutes Application Of A Modality To One Or More Areas Electrical |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 97028. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 97028 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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