CPT 97158 Fee Schedule

Last Verified: July 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.

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.

Key Fact	Detail
Service Type	Physical Medicine and Rehabilitation Therapeutic Procedures Physical Medicine and Rehabilitation Evaluations
Common Place of Service	11 - Office 99 - Other POS
Common Modifiers	None HO U6
Complexity Level	Low
Medicare Fee Schedule	View Medicare rates for 97158

National average reimbursement for CPT 97158 by major payers:

$29.77

$7.25

$21.36

$37.43

Preview provider-level rates for...

For billing codeCPT 97158

Payer	Code	Rate	NPI	Tax ID	State	Specialty
United	97158	$7.09	1073043352 - JACKIE RAJANI	10211494 - CENTRAL MAINE MEDICAL CENTER	IL	Psychiatry Physician (2084P0800X)
United	97158	$9.84	1124195599 - STEVEN WEINSTEIN	362518901 - (IL) THE THRESHOLDS	IL	Psychiatry Physician (2084P0800X)
United	97158	$10.86	1851540165 - RAJA GILL	363305449 - (IL) MOUNT SINAI COMMUNITY FOUNDATION	IL	Psychiatry Physician (2084P0800X)
United	97158	$11.57	1326465436 - MUSADDIQ TARIQ	370661183 - BLESSING HOSPITAL	IL	Psychiatry Physician (2084P0800X)
United	97158	$10.86	1710328703 - ALI ANWAR	362312495 - (IL) ECKER CENTER FOR BEHAVIORAL HEALTH INC	MO	Psychiatry Physician (2084P0800X)
United	97158	$13.81	1225211600 - JOHN MILLICHAP	260899565 - MERCY SPECIALTY CLINIC	CO	Neurology with Special Qualifications in Child Neurology Physician (2084N0402X)
United	97158	$9.84	1679968697 - JEREMIAH BREWER	384010612	TX	Psychiatry Physician (2084P0800X)
United	97158	$10.86	1043306111 - ELEN TYLKIN	364465212 - (IL) VERNON HILLS MEDICAL CENTER LTD	IL	Psychiatry Physician (2084P0800X)
United	97158	$10.44	1093243149 - KRISTIN ROSSEAU	362177139 - UNIVERSITY OF CHICAGO	CO	Psychiatry Physician (2084P0800X)
United	97158	$10.86	1316353527 - MADIHA SHABBIR	223682760	IL	Psychiatry Physician (2084P0800X)
United	97158	$12.78	1629046735 - AQEEL KHAN	204454589 - (IL) ADVANCE PSYCHIATRY COUNSELING INC	CT	Psychiatry Physician (2084P0800X)
United	97158	$9.84	1760412621 - RHONDA LAMPEN	370661183 - BLESSING HOSPITAL	IL	Psychiatry Physician (2084P0800X)
United	97158	$12.19	1033328869 - LEAH USTAS	362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION	IL	Psychiatry Physician (2084P0800X)
United	97158	$11.57	1245674159 - KHOA NGUYEN	201202088	IL	Psychiatry Physician (2084P0800X)
United	97158	$12.78	1881918415 - TUSHAR ADVANI	50540914 - SPECIALTY PHYSICIANS OF ILLINOIS, LLC	IL	Psychiatry Physician (2084P0800X)
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist

Want to see your competitors' rates?

Start your trial today to unlock complete access to provider rates and fee schedules in your area.

Run a free sample report

Here's what you can do with PayerPrice

Renegotiate your managed care contracts

Benchmark your current rates against market averages to identify opportunities for rate optimization.

Prospect for new business using fee schedules

Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.

Integrate real-time payer data into your workflows

Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.

Explore state-level rates for free

PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.

CPT 97158 vs. Other Physical Medicine and Rehabilitation Evaluations Codes

The CPT 97158 code is part of the Physical Medicine and Rehabilitation Therapeutic 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 97158 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
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.
97161-CPT	Low	Pt Eval Low Complex 20 Min, Physical Therapy Evaluation Low Complexity Requiring These Components A History With No Personal Factors And Or Comorbidities That Impact The Plan Of Care An Examination Of Body System S Using Standardized Tests And Measures Addressing 1 2 Elements From Any Of The Following Body Structures And Functions Activity Limitations And Or Participation Restrictions A Clinical Presentation With Stable And Or Uncomplicated Characteristics And Clinical Decision Making Of Low Complexity Using Standardized Patient Assessment Instrument And Or Measurable Assessment Of Functional Outcome Typically 20 Minutes Are Spent Face To Face With The Patient And Or Family

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 97158. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 97158 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 97158) and we'll show you how you compare in 15 minutes or less.

Schedule a Demo