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See a sample rate comparisonCPT 97530 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.
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.
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Physical Medicine and Rehabilitation Evaluations |
| Common Place of Service | 11 - Office |
| Common Modifiers | GP - Services delivered under an outpatient physical therapy plan of care 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | $35.07 national non-facility rate (2026) · View Medicare rates for 97530 |
| Medicaid Fee Schedule | $28.40 median of the 7 states in the free preview · View Medicaid rates for 97530 |
National average reimbursement for CPT 97530 by major payers:
$42.43
$37.22
$32.93
$37.71
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CPT 97530
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$100.30Published rateRobert Cusser
Scott & White Clinic
$66.69Published rateGerald Demasters
Alleghany Ear Nose Throat PC / Lewis Gale Physicians LLC / Lewisgale Physicians LLC
$40.31Published rateHamiltion Inpatient Physicians, LLC
Riverview Hospital
$30.61Published rateRoberto Calderon
Westchester Medical Group, P.C. D/B/A Westmed Medical Group
$17.00Published rate
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See a sample payer proposalCPT 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 | 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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