Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 97152 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.
Bhv Id Suprt Assmt By 1 Tech, Behavior Identification Supporting Assessment Administered By One Technician Under The Direction Of A Physician Or Other Qualified Health Care Professional Face To Face With The Patient Each 15 Minutes
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Physical Medicine and Rehabilitation Evaluations |
| Common Place of Service | 11 - Office |
| Common Modifiers | HO TG |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 97152 |
| Medicaid Fee Schedule | $20.56 median of the 7 states in the free preview · View Medicaid rates for 97152 |
National average reimbursement for CPT 97152 by major payers:
$30.60
$55.37
$16.37
$94.44
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 97152.
CPT 97152
5 of 25 sample ratesHigher to lower in this preview
Mark Wainwright
Pediatric Faculty Foundation In
$92.95Published ratePiyush Buch
Piyush C Buch Mdpc
$33.02Published rateRhonda Lampen
Blessing Hospital
$29.87Published rateMusaddiq Tariq
Specialty Physicians Of Illinois, LLC
$24.76Published rateSuraya Kawadry
Blessing Hospital
$22.40Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 97152 vs. Other Physical Medicine and Rehabilitation Evaluations Codes
The CPT 97152 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 97152 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 |
|---|---|---|
| 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 |
| 97152-CPT | Low | Bhv Id Suprt Assmt By 1 Tech, Behavior Identification Supporting Assessment Administered By One Technician Under The Direction Of A Physician Or Other Qualified Health Care Professional Face To Face With The Patient Each 15 Minutes |
| 97153-CPT | Low | Behavior Therapy 15 Mins, Fifteen Minutes Of One-On-One Adaptive Behavior Treatment With A Physician Or Other Health Care Professional. This Therapy Identifies Causes Of Stress Triggers To Anxiety And Patterns Of Response And Helps The Individual Develop New Behaviors. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 97152. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 97152 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 97152) and we'll show you how you compare in 15 minutes or less.