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See a sample rate comparisonCPT 97150 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(S) Grou, Therapeutic Procedure(S) Group (2 Or More Individuals)Therapeutic Procedure(S) Group (2 Or More Individuals)
| 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 | $18.04 national non-facility rate (2026) · View Medicare rates for 97150 |
| Medicaid Fee Schedule | $14.715 median of the 8 states in the free preview · View Medicaid rates for 97150 |
National average reimbursement for CPT 97150 by major payers:
$26.03
$19.06
$17.70
$19.79
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CPT 97150
5 of 25 sample ratesHigher to lower in this preview
Faiz Ahmad
Emory University
$43.16Published rateJon Houseworth
Mountain Spring Vascular
$14.93Published rateAbraham Alvarado-Gonzalez
$12.93Published rateKarl Toussaint
$12.22Published rateBrian Mason
$10.14Published rate
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See a sample payer proposalCPT 97150 vs. Other Physical Medicine and Rehabilitation Evaluations Codes
The CPT 97150 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 97150 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 |
|---|---|---|
| 97140-CPT | Low | Manual Therapy 1 Regions, Manual Therapy Techniques Eg Mobilization Manipulation Manual Lymphatic Drainage Manual Traction 1 Or More Regions Each 15 Minutes |
| 97150-CPT | Low | Therapeutic Procedure(S) Grou, Therapeutic Procedure(S) Group (2 Or More Individuals)Therapeutic Procedure(S) Group (2 Or More Individuals) |
| 97151-CPT | Low | Bhv Id Assmt By Phys Qhp, Behavior Identification Assessment Administered By A Physician Or Other Qualified Health Care Professional Each 15 Minutes Of The Physician S Or Other Qualified Health Care Professional S Time Face To Face With Patient And Or Guardian S Caregiver S Administering Assessments And Discussing Findings And Recommendations And Non Face To Face Analyzing Past Data Scoring Interpreting The Assessment And Preparing The Report Treatment Plan |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 97150. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 97150 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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