CPT 97130 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 | • GN - Services delivered under an outpatient speech language pathology plan of care • None • KX - Requirements specified in the medical policy have been met |
| Complexity Level | Low |
National average reimbursement for CPT 97130 by major payers:
$24.10
$24.47
$22.01
$33.68
| 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 97130 | ||||||
United | 97130 | $16.98 | 1538152939 - IMAGING CENTER OF WEST PALM BEACH LLC, TIC ACQUISITION HOLDING LLC | 421581519 | FL | Radiology Clinic/Center (261QR0200X) |
United | 97130 | $16.55 | 1477874337 - RCHP, NORTH ALABAMA MEDICAL CENTER | 272451336 | AL | General Acute Care Hospital (282N00000X) |
United | 97130 | $20.70 | 1902352008 - PRISMA HEALTH-UPSTATE, PRISMA HEALTH CANCER INST-SPARTANBURG | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 97130 | $21.13 | 1396769964 - JULIE WEBSTER | 853861695 - MUSC COMMUNITY PHYSICIANS | SC | Body Imaging Physician (2085B0100X) |
United | 97130 | $22.77 | 1275608457 - RIDGEVIEW MEDICAL CENTER | 311667875 - RIDGEVIEW MEDICAL CENTER | MN | General Acute Care Hospital (282N00000X) |
United | 97130 | $20.70 | 1043392491 - DOCTORS' HOSPITAL OF SLIDELL, LLC, STERLING SURGICAL HOSPITAL | 522363244 - (LA) DOCTORS HOSPITAL OF SLIDELL LLC | LA | General Acute Care Hospital (282N00000X) |
United | 97130 | $20.70 | 1720747496 - PRISMA HEALTH-UPSTATE, PRISMA HEALTH TRANSPLANT CENTER | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 97130 | $22.03 | 1811641962 - ASHLEY GUGLIOTTA | 651011457 - (FL) ORTHOPEDIC SPECIALISTS OF SW FLORIDA PA | FL | Occupational Therapist (225X00000X) |
United | 97130 | $14.56 | 1619089398 - UNIVERSITY IMAGING CENTER, CHARLES E BUCKLEY, MD, PA | 521153709 - (MD) UNIVERSITY IMAGING CENTER CHARLES E BUCKLEY MD PA | MD | Radiology Clinic/Center (261QR0200X) |
United | 97130 | $24.27 | 1467409540 - MOLECULAR IMAGING OF SUBURBAN CHICAGO, LLC | 201675608 - (IL) MOLECULAR IMAGING OF SUBURBAN CHICAGO LLC | IL | Radiology Clinic/Center (261QR0200X) |
United | 97130 | $39.70 | 1710988373 - WOODLAKE IMAGING, L.L.C. | 300106470 | TX | Radiology Clinic/Center (261QR0200X) |
United | 97130 | $23.95 | 1871988279 - DALE SEGAL | 651011457 - (FL) ORTHOPEDIC SPECIALISTS OF SW FLORIDA PA | FL | Orthopaedic Surgery of the Spine Physician (207XS0117X) |
United | 97130 | $22.77 | 1275217606 - NORTHWEST MISS REGIONAL MEDICAL CENTER, NORTHWEST MISSISSIPPI REGIONAL MEDICAL CENTER | 646001574 | MS | General Acute Care Hospital (282N00000X) |
United | 97130 | $26.90 | 1366505463 - CLIFTON SPRINGS SANITARIUM CO, CLIFTON SPRINGS HOSPITAL AND CLINIC | 160743966 - (NY) CLIFTON SPRINGS SANITARIUM CO | NY | General Acute Care Hospital (282N00000X) |
United | 97130 | $21.84 | 1609984301 - PROGRESSIVE CANCER CARE LLC | 320061469 - (IN) PROGRESSIVE CANCER CARE LLC | IN | Radiation Oncology Clinic/Center (261QX0203X) |
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 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 | 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) |
| 97139-CPT | Low | Physical Medicine Treatment To One Or More Areas Each 15 Minunlisted Procedure (Specify) |
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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