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 | $35.81 | 1639227374 - VIKRAMJIT GILL | 363330928 - (IL) PRESENCE HEALTHCARE SERVICES | MD | Psychiatry Physician (2084P0800X) |
United | 97530 | $60.50 | 1942650130 - MALIK NASSAN | 362679194 - (IL) HEAD & NECK AND COSMETIC SURGERY ASSOCIATES, LLC | IL | Psychiatry Physician (2084P0800X) |
United | 97530 | $26.79 | 1437438249 - KAPIL AEDMA | 430957840 - SWOPE HEALTH SERVICES | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 97530 | $60.50 | 1629177662 - BARBARA TWARDOWSKI | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 97530 | $37.63 | 1578097846 - CHRISTOPHER LOMBARDI | 205566098 | TN | Psychiatry Physician (2084P0800X) |
United | 97530 | $38.31 | 1154749844 - NORA EKEANYA | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | CA | Psychiatry Physician (2084P0800X) |
United | 97530 | $35.81 | 1043606742 - JENIFER LLOYD | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Psychiatry Physician (2084P0800X) |
United | 97530 | $77.94 | 1679526784 - ELTON SMITH | 910844563 | IL | Psychiatry Physician (2084P0800X) |
United | 97530 | $38.31 | 1548279870 - VINOD ALLURI | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | TX | Psychiatry Physician (2084P0800X) |
United | 97530 | $39.06 | 1881918415 - TUSHAR ADVANI | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Psychiatry Physician (2084P0800X) |
United | 97530 | $73.79 | 1497080584 - ELIZABETH HOMAN | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | MN | Psychiatry Physician (2084P0800X) |
United | 97530 | $37.79 | 1225211600 - JOHN MILLICHAP | 260899565 - MERCY SPECIALTY CLINIC | CO | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 97530 | $35.81 | 1508194887 - AYISHA JAMEEL | 363330928 - (IL) PRESENCE HEALTHCARE SERVICES | IL | Psychiatry Physician (2084P0800X) |
United | 97530 | $41.15 | 1871231233 - CONNOR MALDONADO | 541383504 - TOWN CENTER ORTHOPAEDIC ASSOCIATES, P.C. | VA | Physician Assistant (363A00000X) |
United | 97530 | $71.81 | 1649768490 - MARIA SEABAUGH | 611661781 | NY | Endocrinology, Diabetes & Metabolism Physician (207RE0101X) |
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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