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See a sample rate comparisonCPT 97610 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.
Low Frequency Non Thermal Us, Low Frequency Non Contact Non Thermal Ultrasound Including Topical Application S When Performed Wound Assessment And Instruction S For Ongoing Care Per Day
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Physical Medicine and Rehabilitation Evaluations |
| Common Place of Service | 11 - Office |
| Common Modifiers | 59 - Distinct Procedural Service GP - Services delivered under an outpatient physical therapy plan of care |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $397.47 national non-facility rate (2026) · View Medicare rates for 97610 |
| Medicaid Fee Schedule | $247.105 median of the 8 states in the free preview · View Medicaid rates for 97610 |
National average reimbursement for CPT 97610 by major payers:
$356.39
$218.80
$376.86
$567.94
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CPT 97610
5 of 25 sample ratesHigher to lower in this preview
Lauren Schumacher
$2,380.40Published rateEugene Schnitzler
Loyola University Medical Center
$317.66Published rateVikramjit Gill
Presence Healthcare Services
$291.20Published rateShannon Jennings
Ottawa Regional Hospital & Healthcare Center
$225.94Published rateJocelyn Lorenzo
$64.51Published rate
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See a sample payer proposalCPT 97610 vs. Other Physical Medicine and Rehabilitation Evaluations Codes
The CPT 97610 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 97610 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-CPT | Low | Dbrdmt Opn Wnd 1st 20 Cm, Debridement Eg High Pressure Waterjet With Without Suction Sharp Selective Debridement With Scissors Scalpel And Forceps Open Wound Eg Fibrin Devitalized 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 Sq Cm Or Less |
| 97598-CPT | Low | Dbrdmt Opn Wnd Addl 20cm, Debridement Eg High Pressure Waterjet With Without Suction Sharp Selective Debridement With Scissors Scalpel And Forceps Open Wound Eg Fibrin Devitalized 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 Each Additional 20 Sq Cm Or Part Thereof List Separately In Addition To Code For Primary Procedure |
| 97602-CPT | Low | Wound S Care Non Selective, 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 |
| 97610-CPT | Moderate | Low Frequency Non Thermal Us, Low Frequency Non Contact Non Thermal Ultrasound Including Topical Application S When Performed Wound Assessment And Instruction S For Ongoing Care Per Day |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 97610. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 97610 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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Frequently Asked Questions
To find out the cost of a specific medical procedure or service, it's best to look up the fee schedule using its CPT (Current Procedural Terminology) code. For accurate, location-specific pricing information, you can use tools like Payerprice, which offers a fee schedule lookup tool where you can search by CPT code and specific location.
A CPT (Current Procedural Terminology) code is a standardized five-digit code used by healthcare providers to describe medical, surgical, and diagnostic services to payers for reimbursement. These codes are crucial for determining the cost of a procedure. To find the specific cost associated with a CPT code in your area, you can use a fee schedule lookup tool like Payerprice.
Comparing healthcare prices requires access to fee schedules, which vary by location and payer. For a comprehensive comparison based on CPT codes and specific locations, you can utilize specialized tools designed for this purpose. Payerprice, for instance, provides a fee schedule lookup tool that allows users to search with CPT codes and specific locations to get relevant pricing information.
Understanding your out-of-pocket expenses involves knowing the negotiated rates for services and how your insurance plan applies deductibles, co-pays, and co-insurance. While your insurance provider can give you estimates, for detailed fee schedule information that can help you anticipate costs based on CPT codes and your specific location, tools like Payerprice are valuable resources.
Medical procedure costs vary due to numerous factors, including geographic location, the specific healthcare provider or facility, the complexity of the service, and the negotiated rates with different insurance payers. To get a clearer picture of typical costs for a given CPT code in your area, you can use a specialized tool. Payerprice offers a fee schedule lookup tool that allows you to search by CPT code and location to see these variations.