CPT 97755 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 | • 11 - Office • None |
| Common Modifiers | • None • GP - Services delivered under an outpatient physical therapy plan of care • GO - Services delivered under an outpatient occupational therapy plan of care |
| Complexity Level | Low |
National average reimbursement for CPT 97755 by major payers:
$47.14
$38.43
$34.11
$40.78
| 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 97755 | ||||||
United | 97755 | $30.73 | 1215297221 - STEPHANIE HERNANDEZ | 383989996 | IL | Psychiatry Physician (2084P0800X) |
United | 97755 | $37.11 | 1174859284 - MATTHEW NIEDZWIECKI | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | WI | Psychiatry Physician (2084P0800X) |
United | 97755 | $34.70 | 1568752665 - ANDREW KNOX | 362222696 - SWEDISHAMERICAN HOSPITAL | WI | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 97755 | $100.37 | 1740252972 - DAVID HSU | 390817529 - ST VINCENT HOSPITAL-HOSPITAL SISTERS-THIRD ORDER OF ST FRANCIS | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 97755 | $34.22 | 1174859284 - MATTHEW NIEDZWIECKI | 811324691 | CA | Psychiatry Physician (2084P0800X) |
United | 97755 | $72.91 | 1538112859 - FARHA TOKARZ | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 97755 | $37.11 | 1962664789 - JAMIE EVANS | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | VA | Psychiatry Physician (2084P0800X) |
United | 97755 | $58.61 | 1518124932 - RITU TALWAR | 363994258 - (IL) HORIZONS BEHAVIORAL HEALTH LLC | IL | Psychiatry Physician (2084P0800X) |
United | 97755 | $37.84 | 1063972404 - MAANASA BANDLA | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 97755 | $54.22 | 1962767376 - AMAN DEEP SINGH | 770460802 | IL | Psychiatry Physician (2084P0800X) |
United | 97755 | $35.16 | 1215258876 - DARA PUMPHREY-RUIZ | 581672987 - (IL) EDWARD HEALTH VENTURES | MA | Psychiatry Physician (2084P0800X) |
United | 97755 | $75.87 | 1154749844 - NORA EKEANYA | 910844563 | CA | Psychiatry Physician (2084P0800X) |
United | 97755 | $40.81 | 1134236565 - WARREN KAMMERER | 611549647 - (IL) WARREN KAMMERER MD SC | IL | Psychiatry Physician (2084P0800X) |
United | 97755 | $72.91 | 1255534483 - SHALINI CHAWLA | 274089658 - (IL) SHALINI CHAWLA MD LLC | IL | Psychiatry Physician (2084P0800X) |
United | 97755 | $80.19 | 1063471159 - MARK WAINWRIGHT | 911220843 - ASSOCIATION OF UNIVERSITY PHYSICIANS | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
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 97755 vs. Other Physical Medicine and Rehabilitation Evaluations Codes
The CPT 97755 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 97755 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 |
|---|---|---|
| 97537-CPT | Low | Community/Work Reintegration Training (Eg Shopping Transportation Money Management Avocational Activities And/Or Work Environment/ Modification Analysis Work Task Analysis Use Of Assistive Technology Device/ Adaptive Equipment) Direct One-On-One Contact Each 15 Minutes (Revised 01/01/13) |
| 97542-CPT | Low | Wheelchair Management/Propulsion Training |
| 97750-CPT | Low | Physical Performance Test Or Measurement (Eg, Musculoskeletal, Functional Capacity), With Written Report, Each 15 Minutes |
| 97755-CPT | Low | Assistive Technology Assessment (Eg To Restore Augment Or Compensate For Existing Function Optimize Functional Tasks And/Or Maximize Environmental Accessibility) Direct One-On-One Contact With Written Report Each 15 Minutes (Revised 01/01/2013) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 97755. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 97755 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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