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See a sample rate comparisonCPT 97156 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.
Fam Adapt Bhv Tx Gdn Phy Qhp, Family Adaptive Behavior Treatment Guidance Administered By Physician Or Other Qualified Health Care Professional With Or Without The Patient Present Face To Face With Guardian S Caregiver S 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 GT - Via interactive audio and video telecommunication systems |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 97156 |
| Medicaid Fee Schedule | $21.39 median of the 7 states in the free preview · View Medicaid rates for 97156 |
National average reimbursement for CPT 97156 by major payers:
$37.02
$46.37
$21.95
$62.44
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CPT 97156
5 of 25 sample ratesHigher to lower in this preview
Melvin Joseph
Advocate Health And Hospitals Corporation
$64.76Published rateJessica Janusch
Kenzie Cournoyer
$19.73Published rateWilliam Atkins
$17.51Published rateBrittany Garcia
Whole Health Behavior
$14.88Published rateJosalynn Cartagena
Alexandr Vattamala Philip / Center For Emotional Wellness / Counseling Space Lcsw PC
$14.88Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 97156 vs. Other Physical Medicine and Rehabilitation Evaluations Codes
The CPT 97156 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 97156 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 |
|---|---|---|
| 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. |
| 97156-CPT | Low | Fam Adapt Bhv Tx Gdn Phy Qhp, Family Adaptive Behavior Treatment Guidance Administered By Physician Or Other Qualified Health Care Professional With Or Without The Patient Present Face To Face With Guardian S Caregiver S Each 15 Minutes |
| 97157-CPT | Low | Mult Fam Adapt Bhv Tx Gdn, Multiple Family Group Adaptive Behavior Treatment Guidance Administered By Physician Or Other Qualified Health Care Professional Without The Patient Present Face To Face With Multiple Sets Of Guardians Caregivers 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 97156. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 97156 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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Frequently Asked Questions
CPT stands for Current Procedural Terminology. CPT codes are a standardized set of medical codes used by healthcare professionals to report medical, surgical, and diagnostic procedures and services to entities such as insurance companies. They are crucial for accurate billing, processing claims, and tracking healthcare services.
Finding the exact cost of a medical procedure can vary significantly based on your insurance plan, provider, and geographic location. To get an estimate relevant to your specific situation, it's recommended to use tools like Payerprice's fee schedule lookup tool. This tool allows you to search for pricing information by entering a CPT code and your specific location.
CMS (Centers for Medicare & Medicaid Services) is a U.S. federal agency that administers major healthcare programs like Medicare and Medicaid, setting many national healthcare standards and reimbursement rates. Payerprice, on the other hand, is a service that provides a fee schedule lookup tool, helping individuals access pricing information for various medical procedures (based on CPT codes and location) from different payers, facilitating price transparency for consumers, which can include rates beyond just CMS-specific fee schedules.
Healthcare pricing is complex due to several factors, including the intricate web of negotiated rates between insurance companies and providers, variations in pricing based on geographic location and facility type, the lack of a standardized national price list, and the use of 'chargemasters' which are often inflated starting points for billing. Additionally, the emergency nature of some services limits upfront price shopping, and the involvement of multiple payers further complicates the system.
Payerprice assists users by offering a fee schedule lookup tool designed to bring transparency to healthcare costs. By allowing users to search with a specific CPT code and their location, Payerprice provides insights into potential procedure costs. This empowers individuals to compare prices, plan for healthcare expenses, and make more informed decisions about their medical care.