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See a sample rate comparisonCPT 97551 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.
Caregiver Traing Ea Addl 15, Caregiver Training In Strategies And Techniques To Facilitate The Patient S Functional Performance In The Home Or Community Eg Activities Of Daily Living Adls Instrumental Adls Iadls Transfers Mobility Communication Swallowing Feeding Problem Solving Safety Practices Without The Patient Present Face To Face Each Additional 15 Minutes List Separately In Addition To Code For Primary Service
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Physical Medicine and Rehabilitation Evaluations |
| Complexity Level | Low |
| Medicare Fee Schedule | $26.05 national non-facility rate (2026) · View Medicare rates for 97551 |
| Medicaid Fee Schedule | $22.295 median of the 8 states in the free preview · View Medicaid rates for 97551 |
National average reimbursement for CPT 97551 by major payers:
$32.69
$35.69
$26.50
$47.53
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CPT 97551
5 of 25 sample ratesHigher to lower in this preview
Kendra Johnson
Park Nicollet Health Services
$105.81Published rateBrian Farah
Novant Medical Group Inc
$65.58Published rateCorrin Mottern
Ear, Nose & Throat Consultants Of East Tennessee, P.C.
$34.84Published rateLifespring, Inc
Lifespring Inc
$27.47Published rateSarah Mitchell
Marquardt Audiology Hearing Aids PLLC
$21.37Published rate
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See a sample payer proposalCPT 97551 vs. Other Physical Medicine and Rehabilitation Evaluations Codes
The CPT 97551 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 97551 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 |
|---|---|---|
| 97551-CPT | Low | Caregiver Traing Ea Addl 15, Caregiver Training In Strategies And Techniques To Facilitate The Patient S Functional Performance In The Home Or Community Eg Activities Of Daily Living Adls Instrumental Adls Iadls Transfers Mobility Communication Swallowing Feeding Problem Solving Safety Practices Without The Patient Present Face To Face Each Additional 15 Minutes List Separately In Addition To Code For Primary Service |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 97551. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 97551 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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