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 97157 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.
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
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Physical Medicine and Rehabilitation Evaluations |
| Common Place of Service | 11 - Office 10 - Telehealth in Patient's Home |
| Common Modifiers | HO 95 - Telemedicine - audio and video |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 97157 |
| Medicaid Fee Schedule | $13.13 median of the 7 states in the free preview · View Medicaid rates for 97157 |
National average reimbursement for CPT 97157 by major payers:
$34.31
$29.73
$21.61
$266.46
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 97157.
CPT 97157
5 of 25 sample ratesHigher to lower in this preview
Haidar Kabbani
Pediatric Faculty Foundation In
$51.59Published rateCarol Craig
Edgewood Clinical Services
$10.23Published rateChandragupta Vedak
Rosecrance Inc
$8.34Published rateSteven Sharp
$8.34Published rateSteven Sharp
$7.09Published 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 97157 vs. Other Physical Medicine and Rehabilitation Evaluations Codes
The CPT 97157 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 97157 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 |
|---|---|---|
| 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 |
| 97158-CPT | Low | Adaptive Behavior Therapy, Fifteen Minutes Of Adaptive Behavior Treatment With A Physician Or Other Health Care Professional 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 97157. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 97157 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 97157) and we'll show you how you compare in 15 minutes or less.