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See a sample rate comparisonCPT 97154 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.
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.
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Physical Medicine and Rehabilitation Evaluations |
| Common Place of Service | 11 - Office 99 - Other POS None |
| Common Modifiers | None HM HN |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 97154 |
| Medicaid Fee Schedule | View Medicaid rates for 97154 |
National average reimbursement for CPT 97154 by major payers:
$26.68
$6.37
$16.24
$37.17
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CPT 97154
5 of 25 sample ratesHigher to lower in this preview
Birju Patel
Robert Young Center For Community Mental Health
$18.37Published rateDeborah Garrelts-Daoud
Blessing Hospital
$12.35Published rateTrilok Shah
In Touch Physicians LLC
$11.60Published rateMark Alter
Specialty Physicians Of Illinois, LLC
$10.22Published rateVictor Patron Romero
$8.86Published rate
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See a sample payer proposalCPT 97154 vs. Other Physical Medicine and Rehabilitation Evaluations Codes
The CPT 97154 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 97154 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 |
|---|---|---|
| 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. |
| 97155-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 97154. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 97154 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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