CPT 97551 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 |
| Complexity Level | Moderate |
National average reimbursement for CPT 97551 by major payers:
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| 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 97551 | ||||||
United | 97551 | $32.25 | 1295708022 - CHAD SCHULTHEIS | 351913875 - INDIANA UNIVERSITY HEALTH SOUTHERN INDIANA PHYSICIANS | IN | Psychiatry Physician (2084P0800X) |
United | 97551 | $27.64 | 1134333552 - WINDERLYON HEBERT | 760009637 - LEGACY COMMUNITY HEALTH SERVICES INC | TX | Professional Counselor (101YP2500X) |
United | 97551 | $60.09 | 1346881695 - MICHELLE HOSTETLER | 863284696 - OU HEALTH PARTNERS INC | OK | Pediatric Occupational Therapist (225XP0200X) |
United | 97551 | $92.50 | 1053693515 - AMY GROSS | 411843943 - UNIVERSITY OF MINNESOTA PHYSICIANS | MN | Psychologist (103T00000X) |
United | 97551 | $26.89 | 1164645529 - JEAN CRANE | 611630276 - FRANCISCAN PHYSICIAN NETWORK | IN | Mental Health Counselor (101YM0800X) |
United | 97551 | $33.22 | 1881331981 - MORRISON COMMUNITY HOSPITAL DISTRICT | 366008167 | IL | Counselor (101Y00000X) |
United | 97551 | $27.42 | 1811461882 - BRITTANY LEONARD | 351747218 - INDIANA UNIVERSITY HEALTH CARE ASSOCIATES INC | IN | Mental Health Counselor (101YM0800X) |
United | 97551 | $25.52 | 1275625394 - RAYMOND FABER | 651255384 | TX | Psychiatry Physician (2084P0800X) |
United | 97551 | $27.42 | 1912692534 - HANNAH BUCK | 351747218 - INDIANA UNIVERSITY HEALTH CARE ASSOCIATES INC | IN | Clinical Psychologist (103TC0700X) |
United | 97551 | $26.07 | 1770211146 - DAVID HUGHES | 363355817 | IL | Audiologist (231H00000X) |
United | 97551 | $121.83 | 1235504374 - ARIEL NEIKRUG | 952226406 - REGENTS OF THE UNIVERSITY OF CALIFORNIA AT IRVINE | UT | Psychologist (103T00000X) |
United | 97551 | $33.09 | 1447354832 - LIBBY COOK | 381878678 - (MI) MOTT CHILDRENS HEALTH CENTER | MI | Audiologist (231H00000X) |
United | 97551 | $21.51 | 1255880498 - CHRISTINA TINDALL | 316402113 | OH | Speech-Language Pathologist (235Z00000X) |
United | 97551 | $66.16 | 1992092191 - FARAHNAZ RAQIB | 930386823 - LEGACY EMANUEL HOSPITAL & HEALTH CENTER | TX | Psychiatry Physician (2084P0800X) |
United | 97551 | $23.70 | 1588090757 - JONATHAN WILSON | 363377698 - MIDWESTERN UNIVERSITY | IL | Speech-Language Pathologist (235Z00000X) |
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 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 | Moderate | 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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