CPT 97151 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 • None |
| Common Modifiers | • None • HO • U3 |
| Complexity Level | Low |
National average reimbursement for CPT 97151 by major payers:
$42.92
$64.81
$22.27
$95.47
| 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 97151 | ||||||
United | 97151 | $122.81 | 1730567900 - KHUSHBU SHAH | 364187449 | TN | Psychiatry Physician (2084P0800X) |
United | 97151 | $25.39 | 1235209339 - JUDITH WALTERS | 260662255 - (MI) KENFIELD WALTERS INTL LLC | MI | Clinical Psychologist (103TC0700X) |
United | 97151 | $25.39 | 1740656354 - MUNNI DEB | 383844634 - (MI) OAKLAND INTERGRATED HEALTHCARE NETWORK | MI | Psychologist (103T00000X) |
United | 97151 | $29.87 | 1285110593 - DAWN GOLDSTEIN | 260388272 - (IL) SPRINGFIELD HOSPITAL INC | IL | Professional Counselor (101YP2500X) |
United | 97151 | $25.39 | 1104341940 - ANGELA JOURDAIN | 842381182 - (TX) HAVEN OF HOPE PLLC | TX | Mental Health Counselor (101YM0800X) |
United | 97151 | $25.39 | 1194891044 - DEANNA HUGHES | 590242661 | FL | Clinical Psychologist (103TC0700X) |
United | 97151 | $25.39 | 1508992330 - LAURA SECREST | 272365178 | TX | Clinical Psychologist (103TC0700X) |
United | 97151 | $28.05 | 1225408909 - COURTNEY LEE | 870595720 - (UT) CHRYSALIS UTAH LLC | UT | Behavioral Analyst (103K00000X) |
United | 97151 | $29.87 | 1578196838 - ELLEN THANG | 271899667 - (IN) HOPE BEHAVIORAL SERVIES LLC | IN | Behavioral Analyst (103K00000X) |
United | 97151 | $25.39 | 1306248117 - MAXIMILIAN SHAFIR | 852369192 - (NC) KEEP COUNSEL | NC | Clinical Social Worker (1041C0700X) |
United | 97151 | $25.39 | 1689995649 - MEDHAT GUIRGUIS | 823841127 - (TX) MERCY PSYCHIATRY INC | TX | Psychiatry Physician (2084P0800X) |
United | 97151 | $127.05 | 1659714806 - RAVI RAMASAMY | 910564748 - SEATTLE CHILDRENS HOSPITAL | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 97151 | $25.39 | 1265855498 - ANNA KJOSE | 861428755 - (OK) ANNA KJOSE PHD PLLC | OK | Psychologist (103T00000X) |
United | 97151 | $29.87 | 1235719931 - MARY MOREHOUSE | 821871669 - (MN) INSIGHT COUNSELING DULUTH LLC | MN | Clinical Social Worker (1041C0700X) |
United | 97151 | $29.87 | 1245713429 - JOSIE BENNER | 311155352 - HOPEWELL HEALTH CENTERS INC | OH | Social Worker (104100000X) |
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 97151 vs. Other Physical Medicine and Rehabilitation Evaluations Codes
The CPT 97151 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 97151 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 |
|---|---|---|
| 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 |
| 97152-CPT | Low | Behavior Identification-Supporting Assessment Administered By By One Technician Under The Di- Rection Of A Physician Or Other Qualified Health Care Professional Face-To-Face With The Patient 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 97151. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 97151 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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