CPT 97150 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 • 49 - Independent Clinic |
| Common Modifiers | • GP - Services delivered under an outpatient physical therapy plan of care • None • CQ - PT services by assistant |
| Complexity Level | Low |
National average reimbursement for CPT 97150 by major payers:
$26.03
$19.06
$17.70
$19.81
| 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 97150 | ||||||
United | 97150 | $19.73 | 1760970081 - MORGAN GARCIA | 364600607 | FL | Foot & Ankle Surgery Podiatrist (213ES0103X) |
United | 97150 | $12.93 | 1033524459 - JOEL MARTIN | 593259553 - ORLANDO HEALTH MEDICAL GROUP INC | FL | Neurological Surgery Physician (207T00000X) |
United | 97150 | $14.31 | 1770671323 - DOUGLAS COHEN | 223865226 - (FL) DOUGLAS H COHEN DPM PA | FL | Podiatrist (213E00000X) |
United | 97150 | $45.81 | 1184601304 - FEDERICO VINAS | 462021581 - (FL) FLORIDA HOSPITAL PHYSICIAN GROUP INC | FL | Neurological Surgery Physician (207T00000X) |
United | 97150 | $17.54 | 1609878933 - ROBERT TEITELBAUM | 592338973 - (FL) DRROBERT TEITELBAUM | FL | Foot & Ankle Surgery Podiatrist (213ES0103X) |
United | 97150 | $16.88 | 1104037027 - JOSHUA COCKRELL | 631119002 - (AL) BIRMINGHAM HEART CLINIC, PC | AL | Interventional Cardiology Physician (207RI0011X) |
United | 97150 | $13.38 | 1245526607 - GUNJAN GOEL | 30485325 - (FL) BROWARD NEUROSURGEONS LLC | FL | Neurological Surgery Physician (207T00000X) |
United | 97150 | $12.22 | 1598175390 - BROCK FOSTER | 461243081 | FL | Orthopaedic Trauma Physician (207XX0801X) |
United | 97150 | $15.85 | 1932456001 - JON HOUSEWORTH | 451687467 - (VA) SARA BOURAEE LLC | VA | Foot & Ankle Surgery Podiatrist (213ES0103X) |
United | 97150 | $12.22 | 1033644133 - KARL TOUSSAINT | 473808924 | FL | Orthopaedic Trauma Physician (207XX0801X) |
United | 97150 | $13.14 | 1861876054 - ANH NGUYEN | 202961885 - (FL) ADVANCED PODIATRY PA | FL | Podiatrist (213E00000X) |
United | 97150 | $17.76 | 1669677514 - DEVON HAYDON | 593140335 - BAYCARE MEDICAL GROUP INC | FL | Neurological Surgery Physician (207T00000X) |
United | 97150 | $10.88 | 1720268634 - BARRETT SACHS | 650429853 | FL | Foot & Ankle Surgery Podiatrist (213ES0103X) |
United | 97150 | $12.93 | 1104480284 - ALEXIS MUGNO | 593696338 - (FL) SOUTHEAST ORTHOPEDIC SPECIALISTS, INC. | FL | Podiatrist (213E00000X) |
United | 97150 | $16.62 | 1033159009 - DAVID THOMPSON | 592929608 - (FL) MUSCULOSKELETAL INSTITUTE INC. FLORIDA ORTHOPAEDIC INSTITUTE | FL | Sports Medicine (Orthopaedic Surgery) Physician (207XX0005X) |
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 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 Techniques (Eg, Mobilization/ Manipulation, Manual Lymphatic Drainage, Manual Traction), 1 Or More Regions, Each 15 Minutes |
| 97150-CPT | Low | Therapeutic Procedure(S), Group (2 Or More Individuals) |
| 97151-CPT | Low | Behavior Identification Assessment Admini- Stered By A Physician Or Other Qualified Health Care Professional Each 15 Minutes Of The Physi- Cians Or Other Qualified Health Care Profession- Als Time Face-To-Face With Patient And/Or Guar- Dian(S)/Caregiver(S) Administering Assessments Anddiscussing Findings And Recommendations And Non- Face-To-Face Analyzing Past Data Scoring/Inter- Preting 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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