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See a sample rate comparisonCPT 97158 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.
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 | Medicine Services and Procedures Physical Medicine and Rehabilitation Evaluations |
| Common Place of Service | 11 - Office 99 - Other POS |
| Common Modifiers | HO U6 |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 97158 |
| Medicaid Fee Schedule | $9.34 median of the 7 states in the free preview · View Medicaid rates for 97158 |
National average reimbursement for CPT 97158 by major payers:
$29.77
$7.25
$21.36
$37.43
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CPT 97158
5 of 25 sample ratesHigher to lower in this preview
Birju Patel
Trinity Medical Center
$14.64Published rateMarc Sandrolini
Edgewood Clinical Services
$12.10Published rateSyed Khan
Loyola University Medical Center
$11.31Published rateJohn Millichap
Monument Health Rapid City Hospital Inc
$9.98Published rateJackie Rajani
Central Maine Medical Center
$7.09Published rate
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See a sample payer proposalCPT 97158 vs. Other Physical Medicine and Rehabilitation Evaluations Codes
The CPT 97158 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 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.
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