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See a sample rate comparisonCPT 97153 Fee Schedule
Last Verified: September 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.
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.
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Physical Medicine and Rehabilitation Evaluations |
| Common Place of Service | 11 - Office None |
| Common Modifiers | None HM HN |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 97153 |
| Medicaid Fee Schedule | View Medicaid rates for 97153 |
National average reimbursement for CPT 97153 by major payers:
$27.76
$44.46
$16.86
$61.13
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CPT 97153
5 of 25 sample ratesHigher to lower in this preview
Conrad Deguzman
Hannah Hendricks
$18.79Published rateKiersten Perez
$16.59Published rateAmit Anand
Olga Terechin
$15.77Published rateCodie Vassar
Brain Treatment Center Glenview
$14.18Published rateNtiense Covey
Etsah Counseling Center PLLC
$12.51Published rate
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See a sample payer proposalCPT 97153 vs. Other Physical Medicine and Rehabilitation Evaluations Codes
The CPT 97153 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 97153 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 |
|---|---|---|
| 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. |
| 97154-CPT | Low | Group Behavior Therapy 15 Min, Fifteen Minutes Of Adaptive Behavior Treatment With A Technician In A Group Setting. 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 97153. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 97153 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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