Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 97113 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.
Therapeutic Procedure One Or, Therapeutic Procedure One Or More Areas Each 15 Minutesaquatic Therapy With Therapeutic Exercisestherapeutic Procedure One Or More Areas Each 1 5 Minutes
| 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 | $37.08 national non-facility rate (2026) · View Medicare rates for 97113 |
| Medicaid Fee Schedule | $30.02 median of the 7 states in the free preview · View Medicaid rates for 97113 |
National average reimbursement for CPT 97113 by major payers:
$36.94
$39.46
$36.06
$39.75
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 97113.
CPT 97113
5 of 25 sample ratesHigher to lower in this preview
Ram Saha
Mcv Associated Physicians
$80.16Published rateHouston Vamc
$42.36Published rateAdam Mussman
Professional Radiology, Inc.
$34.93Published rateApurva Shah
Slocum Dickson Medical Group PLLC
$34.58Published rateMcallen Hospitals L P, South Texas Health System
$33.68Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 97113 vs. Other Physical Medicine and Rehabilitation Evaluations Codes
The CPT 97113 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 97113 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 |
|---|---|---|
| 97112-CPT | Low | Muscle Or Nerve Training, A 15-Minute Session Of Therapist-Assisted Activities Designed To Reeducate The Nerves And Muscles In How To Work Together. Focus Is On Movement Balance Coordination Posture And Alignment For Sitting And Standing. |
| 97113-CPT | Low | Therapeutic Procedure One Or, Therapeutic Procedure One Or More Areas Each 15 Minutesaquatic Therapy With Therapeutic Exercisestherapeutic Procedure One Or More Areas Each 1 5 Minutes |
| 97116-CPT | Low | Therapeutic Procedure One Or, Therapeutic Procedure One Or More Areas Each 15 Minutesgait Training (Includes Stair Climbing) Therapeutic Procedure One Or More Areas Each 15 Minutes |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 97113. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 97113 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 97113) and we'll show you how you compare in 15 minutes or less.