CPT 97530 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | • Medicine Services and Procedures • Physical Medicine and Rehabilitation Evaluations |
| Common Place of Service | • 11 - Office • None |
| Common Modifiers | • GP - Services delivered under an outpatient physical therapy plan of care • None • 59 - Distinct Procedural Service |
| Complexity Level | Low |
National average reimbursement for CPT 97530 by major payers:
$42.43
$37.22
$32.93
$39.16
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 97530 | ||||||
United | 97530 | $27.44 | 1912402520 - CASEY FISHER, M.D., A PROFESSIONAL CORPORATION | 474918786 - CASEY FISHER MD A PROFESSIONAL CORPORATION | CA | Pain Medicine (Physical Medicine & Rehabilitation) Physician (2081P2900X) |
United | 97530 | $100.30 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 97530 | $97.66 | 1023172418 - BARBARA CUSUMANO | 112571524 - (NY) STONY BROOK CHILDRENS SERVICE UNIVERSITY FACULTY PRACTICE CORP | NY | Pediatrics Physician (208000000X) |
United | 97530 | $43.08 | 1740713726 - LAUREN BOWERS | 351747218 - INDIANA UNIVERSITY HEALTH CARE ASSOCIATES INC | IN | Clinical Social Worker (1041C0700X) |
United | 97530 | $40.31 | 1164746988 - GERALD DEMASTERS | 61755234 - (VA) ALLEGHANY EAR NOSE THROAT PC / LEWIS GALE PHYSICIANS LLC / LEWISGALE PHYSICIANS LLC | VA | Psychiatry Physician (2084P0800X) |
United | 97530 | $66.69 | 1902226095 - ROBERT CUSSER | 742958277 - SCOTT & WHITE CLINIC | TX | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 97530 | $17.00 | 1831654060 - LEAHANA MOLZAHN | 112552333 - (NY) STONY BROOK SURGICAL ASSOCIATES UNIVERSITY FACULTY PRACTICE CORP | NY | Surgery Physician (208600000X) |
United | 97530 | $27.87 | 1780051433 - VJOLKA ZAKA | 383876436 | FL | Audiologist (231H00000X) |
United | 97530 | $84.23 | 1336594209 - ASHLEY MOELLER | 264529479 - (IN) INDIANA CLINICNEUROLOGY LLC | IN | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 97530 | $25.48 | 1063684215 - CAROL PETILLO | 261711211 - (SC) GREER AUDIOLOGY LLC | NC | Audiologist (231H00000X) |
United | 97530 | $67.07 | 1851918718 - VERONICA LEE | 953123703 - GRAYBILL MEDICAL GROUP, INC. | CA | Family Medicine Physician (207Q00000X) |
United | 97530 | $39.47 | 1427218775 - REENAL PATEL | 824714427 | NY | Allergy & Immunology Physician (207K00000X) |
United | 97530 | $32.09 | 1881110393 - OLIVIA EHRLICH | 592929608 - (FL) MUSCULOSKELETAL INSTITUTE INC. FLORIDA ORTHOPAEDIC INSTITUTE | FL | Occupational Therapist (225X00000X) |
United | 97530 | $73.48 | 1730797481 - SARA MATHERLY | 561732213 | NC | Psychologist (103T00000X) |
United | 97530 | $38.27 | 1427739713 - MADELEINE RUCKER | 200561474 - (OK) MCBRIDE ORTHOPEDIC HOSPITAL | OK | Audiologist (231H00000X) |
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 |
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CPT 97530 vs. Other Physical Medicine and Rehabilitation Evaluations Codes
The CPT 97530 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 97530 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 |
|---|---|---|
| 97172-CPT | Low | Re-Evaluation Of Athletic Training Established Plan Of Care Requiring These Components: An Assessment Of Patients Current Functional Status When There Is A Documented Change ; And A Revised Plan Of Care Using Standardized Patient Assessmentinstrument And/Or Measurable Assessment Of Func- Tional Outcome With An Update In Management Options Goals And Interventions. Typically 20minutes Are Spent Face-To-Face With The Patient And/Or Family |
| 97530-CPT | Low | Therapeutic Activities Direct (One-On-One) Patient Contact (Use Of Dynamic Activities To Improve Functional Performance) Each 15 Minutes (Revised 01/01/13) |
| 97533-CPT | Low | Sensory Integrative Techniques To Enhance Sensory Processing And Promote Adaptive Responses To Environmental Demands Direct (One-On-One) Patientcontact Each 15 Minutes (Revised 01/01/13) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 97530. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 97530 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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