CPT 97605 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 | • 21 - Inpatient Hospital • 11 - Office |
| Common Modifiers | • None • 59 - Distinct Procedural Service • GP - Services delivered under an outpatient physical therapy plan of care |
| Complexity Level | Moderate |
National average reimbursement for CPT 97605 by major payers:
$48.57
$42.52
$55.95
$68.59
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
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CPT 97605 vs. Other Physical Medicine and Rehabilitation Evaluations Codes
The CPT 97605 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 97605 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 |
|---|---|---|
| 97597 | Low | Debridement (Eg High Pressure Waterjet With/Without Suction Sharp Selective Debridement With Scissors Scalpel And Forcepts) Open Wound (Eg Fibrin Deviatelized Epidermis And/Or Dermis Exudate Debris Biofilm) Including Topical Application(S) Wound Assessment Use Of A Whirlpool When Performed And Instruction(S) For Ongoing Care Per Session Total Wound(S) Surface Area; First 20 Square Centimeters Or Less |
| 97598 | Low | Debridement (Eg High Pressure Waterjet With/Without Suction Sharp Selective Debridement With Scissors Scalpel And Forceps) Open Wound (Ed Fibrin Deviatlized Epidermis And/Or Dermis Exudate Debris Biofilm) Including Topical Application(S) Wound Assessment Use Of A Whirlpool When Performed And Instruction(S) For Ongoing Care Per Sessioneach Additional 20 Sq Cm Or Part Thereof (List Separately In Addition To Code For Primary Procedure |
| 97602 | Low | Removal Of Devitalized Tissue From Wound(S) Non-Selective Debridement Without Anesthesia (Eg Wet-To-Moist Dressings Enzymatic Abrasion Larval Therapy) Including Topical Application(S) Wound Assessment And Instruction(S) For Ongoing Care Per Session. (Desc Revised 1/1/2017) |
| 97605 | Low | Negative Pressure Wound Therapy (Eg Vacuum Assited Drainage Collection) Utilizing Durable Medical Equipment (Dme) Including Topical Application(S) Wound Assessment And Instruction(S) For Ongoing Care Per Session; Total Wound(S) Surface Area Less Than Or Equal To 50 Square Centimeters (Desc Revised 01/01/15) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 97605. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 97605 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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Medicare Reimbursement Lookup Tool
Medicare localities are geographic regions used to adjust reimbursement rates based on local costs. Rates vary by locality to reflect differences in wages, rent, and other expenses. Sign up to see commercial rates (United/BCBS/Cigna/Aetna)
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| Year | Billing Code | Locality | Non-Facility Fee | Facility Fee |
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