CPT 97112 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 • Physical Medicine and Rehabilitation Evaluations |
| Common Place of Service | • 11 - Office • None |
| Common Modifiers | • GP - Services delivered under an outpatient physical therapy plan of care • None • CQ - PT services by assistant |
| Complexity Level | Low |
National average reimbursement for CPT 97112 by major payers:
$39.65
$34.21
$30.85
$36.16
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 97112 | ||||||
United | 97112 | $50.36 | 1225211600 - JOHN MILLICHAP | 454158203 - COMMUNITY CARE NETWORK INC | NC | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 97112 | $40.72 | 1568705622 - IUNIA DADARLAT | 352030653 - ARNETT CLINIC LLC | IL | Psychiatry Physician (2084P0800X) |
United | 97112 | $27.73 | 1760419311 - PETER HEYDEMANN | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 97112 | $69.59 | 1881918415 - TUSHAR ADVANI | 910844563 | IL | Psychiatry Physician (2084P0800X) |
United | 97112 | $37.58 | 1932272952 - MOHAMMED HOMSI | 452353153 - (IL) HOMSI PEDIATRIC NEUROLOGY INC | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 97112 | $53.95 | 1497080584 - ELIZABETH HOMAN | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IA | Psychiatry Physician (2084P0800X) |
United | 97112 | $28.60 | 1063891232 - BIKRAM SHARMA | 364340137 - (IL) SAINT ANTHONY HEALTH AFFILIATES | OH | Psychiatry Physician (2084P0800X) |
United | 97112 | $31.94 | 1245484740 - CHALONGCHAI PHITSANUWONG | 362177139 - UNIVERSITY OF CHICAGO | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 97112 | $53.95 | 1760461867 - RITA YADAVA | 363878197 - (IL) RITA YADAVA MDSC | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 97112 | $54.91 | 1326177809 - LAURA SHEA | 364143823 - SIU PHYSICIANS & SURGEONS INC | IL | Psychiatry Physician (2084P0800X) |
United | 97112 | $82.19 | 1649653106 - KEVIN PARK | 522228444 | DC | Orthopaedic Surgery Physician (207X00000X) |
United | 97112 | $36.09 | 1659618643 - ARIZONA SPINE CONSULTANTS | 860841293 | AZ | Orthopaedic Surgery of the Spine Physician (207XS0117X) |
United | 97112 | $73.16 | 1649653106 - KEVIN PARK | 522228444 | DC | Orthopaedic Surgery Physician (207X00000X) |
United | 97112 | $36.09 | 1205570181 - GOLDEN STATE CARE PC | 881322793 - GOLDEN STATE CARE PC | CA | Family Medicine Physician (207Q00000X) |
United | 97112 | $27.20 | 1639387061 - CHRISTOPHER HENDERSON | 760423386 | IA | Orthopaedic Surgery Physician (207X00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 97112 vs. Other Physical Medicine and Rehabilitation Evaluations Codes
The CPT 97112 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 97112 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 |
|---|---|---|
| 97110-CPT | Low | Therapeutic Procedure, 1 Or More Areas, Each 15 Minutes; Therapeutic Exercises To Develop Strength And Endurance, Range Of Motion And Flexibility |
| 97112-CPT | Low | Therapeutic Procedure, 1 Or More Areas, Each 15 Minutes; Neuromuscular Reeducation Of Movement, Balance, Coordination, Kinesthetic Sense, Posture, And/Or Proprioception For Sitting And/Or Standing Activities |
| 97113-CPT | Low | Theraputic Prc, 1/Mre Areas, Ea 15 Min; Aquatc Therapy W/Theraptc Exc |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 97112. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 97112 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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