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 | Physical Medicine and Rehabilitation Therapeutic 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 |
| Medicare Fee Schedule | View Medicare rates for 97530 |
National average reimbursement for CPT 97530 by major payers:
$42.43
$37.22
$32.93
$37.71
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
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 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 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 | Athletic Trn Re Eval Plan Cr, Re Evaluation Of Athletic Training Established Plan Of Care Requiring These Components An Assessment Of Patient S Current Functional Status When There Is A Documented Change And A Revised Plan Of Care Using A Standardized Patient Assessment Instrument And Or Measurable Assessment Of Functional Outcome With An Update In Management Options Goals And Interventions Typically 20 Minutes Are Spent Face To Face With The Patient And Or Family |
| 97530-CPT | Low | Activity Therapy, Activity Therapy Provided One-On-One To Improve A Persons Ability To Participate In Or Perform Daily Physical Social Or Other Life Activities. The Therapy Includes Active Body Movements Such As Lifting Reaching Or Bending. |
| 97533-CPT | Low | Sensory Integrative Techniques, Sensory Integrative Techniques To Enhance Sensory Processing And Promote Adaptive Responses To Environmental Demands Direct (One On One) Patient Contact By The Provider Each 15 Minutes |
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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