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See a sample rate comparisonCPT 97039 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.
Unlisted Modality (Specify Typ, Unlisted Modality (Specify Type And Time If Constantattendance) Unlisted Modality (Specify Type Andtime If Constant
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Physical Medicine and Rehabilitation Evaluations |
| Common Place of Service | 11 - Office 50 - Federally Qualified Health Center |
| Common Modifiers | GP - Services delivered under an outpatient physical therapy plan of care 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 97039 |
| Medicaid Fee Schedule | $14.52 median of the 7 states in the free preview · View Medicaid rates for 97039 |
National average reimbursement for CPT 97039 by major payers:
$108.05
$14.58
$11.76
$13.68
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CPT 97039
5 of 25 sample ratesHigher to lower in this preview
Daniel Bateman
Dartmouth-Hitchcock Clinic
$102.58Published rateDa Pediatric Rehabilitation
$55.00Published rateDa Pediatric Rehabilitation
$40.00Published rateSophia Kecala
Metropolitan Family Services
$23.45Published rateCha Hollywood Medical Center, Lp, Hollywood Presbyterian Medical Center
$10.00Published rate
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See a sample payer proposalCPT 97039 vs. Other Physical Medicine and Rehabilitation Evaluations Codes
The CPT 97039 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 97039 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 |
|---|---|---|
| 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 |
| 97039-CPT | Low | Unlisted Modality (Specify Typ, Unlisted Modality (Specify Type And Time If Constantattendance) Unlisted Modality (Specify Type Andtime If Constant |
| 97110-CPT | Low | Therapeutic Procedure One Or, Therapeutic Procedure One Or More Areas Each 15 Minutestherapeutic Exercises To Develop Strength And Endurance Range Of Motion And Flexibility |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 97039. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 97039 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
To get an estimate for a medical procedure, identify its CPT (Current Procedural Terminology) code. Then, use a fee schedule lookup tool like Payerprice, which allows you to search with the CPT code and your specific location to find relevant pricing information. You can also contact your insurance provider or the healthcare facility directly for a personalized estimate.
A CPT (Current Procedural Terminology) code is a standardized five-digit code used by healthcare providers to describe medical, surgical, and diagnostic services. It's crucial for understanding costs because it allows you to look up and compare prices for specific procedures across different providers and locations. Knowing the CPT code helps you get accurate pricing information, for instance, through a tool like Payerprice.
Medical procedure costs can vary significantly due to factors like the specific healthcare provider's overhead, geographic location, negotiated rates with different insurance companies, the complexity of the procedure, and whether the provider is in-network or out-of-network for your insurance plan. To compare potential costs for a specific procedure in your area, you can use tools like Payerprice by searching with the CPT code and your location.
For specific pricing information on medical services in your local area, you should use a fee schedule lookup tool. Payerprice offers a tool where you can search using a CPT code and your specific location to find relevant pricing data. This allows you to compare costs and make informed decisions about your healthcare.
Yes, Payerprice is designed to help you compare prices. Its fee schedule lookup tool allows you to search for services using CPT codes and specific locations, which can help you understand the potential cost differences for the same procedure across various providers or regions. This enables you to make more informed decisions based on pricing transparency.