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See a sample rate comparisonCPT 97035 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 Ultrasound Each 15 Minutes Application Of A Modality To One Or More Areas Ultrasound
| 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 GO - Services delivered under an outpatient occupational therapy plan of care |
| Complexity Level | Low |
| Medicare Fee Schedule | $14.36 national non-facility rate (2026) · View Medicare rates for 97035 |
| Medicaid Fee Schedule | $12.02 median of the 7 states in the free preview · View Medicaid rates for 97035 |
National average reimbursement for CPT 97035 by major payers:
$14.17
$14.11
$14.99
$14.72
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CPT 97035
5 of 25 sample ratesHigher to lower in this preview
Donald Hart
$61.20Published rateLea Yost
$28.54Published rateTemple Vamc
$14.28Published rateJulianne Brock
$12.92Published ratePhong Ha
Professional Radiology, Inc.
$10.60Published rate
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See a sample payer proposalCPT 97035 vs. Other Physical Medicine and Rehabilitation Evaluations Codes
The CPT 97035 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 97035 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 |
|---|---|---|
| 97034-CPT | Low | Application Of A Modality To O, Application Of A Modality To One Or More Areas Contrastbaths Each 15 Minutes Application Of A Modality To One Or More Areas Contrast |
| 97035-CPT | Low | Application Of A Modality To O, Application Of A Modality To One Or More Areas Ultrasound Each 15 Minutes Application Of A Modality To One Or More Areas Ultrasound |
| 97036-CPT | Low | Application Of A Modality To O, Application Of A Modality To One Or More Areas Hubbardtank Each 15 Minutes Application Of A Modality To One Or More Areas Hubbard |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 97035. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 97035 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 (Current Procedural Terminology) codes are a set of medical codes used by physicians, healthcare providers, and payers to describe medical, surgical, and diagnostic services. They are essential for billing and for understanding the specific procedures performed.
To find the cost of a medical procedure, service, or consultation, especially for your specific location and CPT code, it's best to use a specialized fee schedule lookup tool. We recommend using Payerprice, which offers a tool to search for specific CPT codes and locations to get an estimated cost. This provides more accurate information for individual patient pricing than general government resources.
Healthcare pricing varies widely due to a multitude of factors, including the specific healthcare provider, geographic location, insurance company contracts, the patient's insurance plan, and whether the provider is in-network or out-of-network. Different payers negotiate different rates with providers, leading to a complex pricing landscape.
Payerprice is a platform that provides a fee schedule lookup tool, designed to help users search for the cost of medical procedures based on CPT codes and specific locations. It helps individuals understand potential costs for healthcare services, promoting price transparency. Instead of relying on general information, Payerprice allows you to get more tailored pricing insights for your specific needs.