CPT 97129 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 • 99 - Other POS |
| Common Modifiers | • None • GN - Services delivered under an outpatient speech language pathology plan of care • KX - Requirements specified in the medical policy have been met |
| Complexity Level | Low |
National average reimbursement for CPT 97129 by major payers:
$24.40
$25.54
$22.88
$34.77
| 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 97129 | ||||||
United | 97129 | $24.09 | 1528670510 - MEGAN GORDON | 311483173 - ORTHOALLIANCE MSO, LLC | OH | Physical Therapist (225100000X) |
United | 97129 | $20.47 | 1730738378 - PHILIP BIVIANO | 851040784 | OH | Physical Therapist (225100000X) |
United | 97129 | $24.09 | 1720286974 - MARY TOWNE | 272413974 | OH | Physical Therapist (225100000X) |
United | 97129 | $24.09 | 1205269990 - LINDSEY WEEAST | 311483173 - ORTHOALLIANCE MSO, LLC | OH | Physical Therapist (225100000X) |
United | 97129 | $30.26 | 1609535236 - JOSHUA BICHSEL | 200503812 - (OH) ORTHOPEDIC ONE, INC. | OH | Physical Therapist (225100000X) |
United | 97129 | $53.59 | 1013364835 - BRANDY GOLDEN | 200174459 - (GA) EMORY PHYSICAL THERAPY LLC | OH | Physical Therapist (225100000X) |
United | 97129 | $24.09 | 1821796335 - RYAN THEILE | 311483173 - ORTHOALLIANCE MSO, LLC | OH | Physical Therapist (225100000X) |
United | 97129 | $23.76 | 1235119231 - SHANE INSKEEP | 561079264 - EMERGEORTHO, P.A. | OH | Physical Therapist (225100000X) |
United | 97129 | $32.97 | 1033865290 - RACHEL DILLER | 341963354 - (OH) NORTHWEST OHIO ORTHOPEDICS AND SPORTS MEDICINE, INC. | OH | Physical Therapist (225100000X) |
United | 97129 | $24.09 | 1033122593 - TIMOTHY TAYLOR | 340936207 - TOLEDO CLINIC, INC. | OH | Physical Therapist (225100000X) |
United | 97129 | $31.03 | 1851178578 - NICHOLAS UNTCH | 200503812 - (OH) ORTHOPEDIC ONE, INC. | OH | Physical Therapist (225100000X) |
United | 97129 | $30.26 | 1871228098 - ANDREW TIMMONS | 200503812 - (OH) ORTHOPEDIC ONE, INC. | OH | Physical Therapist (225100000X) |
United | 97129 | $30.26 | 1558610790 - RYAN SANTANGELO | 200503812 - (OH) ORTHOPEDIC ONE, INC. | OH | Physical Therapist (225100000X) |
United | 97129 | $21.77 | 1407304116 - CAROLINE WUST | 540885859 - (VA) ORTHOVIRGINIA, INC. | VA | Physical Therapist (225100000X) |
United | 97129 | $24.09 | 1770065062 - JOSHUA STONE | 311657245 - (OH) OHIO STATE UNIVERSITY | OH | Physical Therapist (225100000X) |
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 97129 vs. Other Physical Medicine and Rehabilitation Evaluations Codes
The CPT 97129 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 97129 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 |
|---|---|---|
| 97124-CPT | Low | Therapeutic Procedure, 1 Or More Areas, Each 15 Minutes; Massage, Including Effleurage, Petrissage And/Or Tapotement (Stroking, Compression, Percussion) |
| 97129-CPT | Low | Therapeutic Interventions That Focus On Cognitive Function (Eg Attention Memory Reasoning Executive Function Problem Solving And/Or Pragmatic Functioning) And Compensatory Strategies To Manage The Performance Of An Activity (Eg Managing Time Or Schedules Initiating Organizing And Sequencing Tasks) Direct (One-On-One) Patient Contact; Initial 15 Minutes |
| 97130-CPT | Low | Therapeutic Interventions That Focus On Cognitive Function (Eg Attention Memory Reasoning Executive Function Problem Solving And/Or Pragmatic Functioning) And Compensatory Strategies To Manage The Performance Of An Activity (Eg Managing Time Or Schedules Initiating Organizing And Sequencing Tasks) Direct (One-On-One) Patient Contact; Each Additional 15 Minutes (List Separately In Additionto Code For Primary Procedure) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 97129. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 97129 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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