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See a sample rate comparisonCPT 97130 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.
Ther Ivntj Ea Addl 15 Min, 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 Addition To Code For Primary Procedure
| 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 | 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 |
| Medicare Fee Schedule | $21.04 national non-facility rate (2026) · View Medicare rates for 97130 |
| Medicaid Fee Schedule | $17.41 median of the 8 states in the free preview · View Medicaid rates for 97130 |
National average reimbursement for CPT 97130 by major payers:
$24.10
$24.47
$22.01
$33.43
Compare published rates across providers.
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CPT 97130
5 of 25 sample ratesHigher to lower in this preview
Bon Secours Diagnostic Imaging, St. Francis Millennium
Bon Secours Diagnostic Imaging
$46.72Published rateDale Segal
Orthopedic Specialists Of Sw Florida PA
$23.95Published rateCoulter Imaging Center LLC
$21.84Published ratePrisma Health-Upstate, Prisma Health Transplant Center
Prisma Health - Upstate
$20.70Published rateUniversity Imaging Center, Charles E Buckley, Md, PA
University Imaging Center Charles E Buckley Md PA
$14.56Published rate
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See a sample payer proposalCPT 97130 vs. Other Physical Medicine and Rehabilitation Evaluations Codes
The CPT 97130 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 97130 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 |
|---|---|---|
| 97129-CPT | Low | Ther Ivntj 1st 15 Min, 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 | Ther Ivntj Ea Addl 15 Min, 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 Addition To Code For Primary Procedure |
| 97139-CPT | Low | Therapeutic Procedure One Or, Therapeutic Procedure One Or More Areas Each 15 Minutesunlisted Therapeutic Procedure (Specify) 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 97130. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 97130 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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