CPT 97760 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 • 20 - Urgent Care Facility |
| Common Modifiers | • None • GO - Services delivered under an outpatient occupational therapy plan of care • GP - Services delivered under an outpatient physical therapy plan of care |
| Complexity Level | Low |
National average reimbursement for CPT 97760 by major payers:
$56.45
$44.08
$39.30
$57.75
| 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 97760 | ||||||
United | 97760 | $142.32 | 1942657556 - DEREK STENQUIST | 42312909 - MASS GENERAL BRIGHAM INCORPORATED | MA | Orthopaedic Trauma Physician (207XX0801X) |
United | 97760 | $34.36 | 1356853584 - BRAIN AND SPINE NEUROSCIENCE INSTITUTE, LLC | 811694342 - (FL) THE BRAIN AND SPINE NEUROSCIENCE | FL | Neurological Surgery Physician (207T00000X) |
United | 97760 | $34.36 | 1639392004 - FLORIDA NEUROSURGICAL ASSOCIATES PA | 593241243 - (FL) FLORIDA NEUROSURGICAL ASSOCIATES, P.A. | FL | Neurological Surgery Physician (207T00000X) |
United | 97760 | $34.36 | 1154469187 - GLENN OSTERWEIL | 593530926 - (FL) KG HEALTH PARTNERS INC | FL | Podiatrist (213E00000X) |
United | 97760 | $25.67 | 1851599922 - LISA CRIGLER | 461399807 - (FL) CRIGLER FOOT ANKLE CENTER LLC | FL | Foot & Ankle Surgery Podiatrist (213ES0103X) |
United | 97760 | $45.11 | 1770640856 - ZEGUANG REN | 300520570 - (TX) METHODIST HOSPITAL | FL | Neurological Surgery Physician (207T00000X) |
United | 97760 | $26.62 | 1902428972 - TRIANTAFILOS IAKOVIDIS | 591867898 - (FL) BOND & STEELE CLINIC PA | FL | Foot & Ankle Surgery Podiatrist (213ES0103X) |
United | 97760 | $34.58 | 1417989302 - LAWRENCE HANDLER | 133755487 | FL | Podiatrist (213E00000X) |
United | 97760 | $26.37 | 1891876165 - OCALA NEUROSURGICAL CENTER PA, OCALA NEUROSURGICAL CENTER | 593178177 - (FL) OCALA NEUROSURGICAL CENTER, P.A. | FL | Neurological Surgery Physician (207T00000X) |
United | 97760 | $35.90 | 1356621130 - JOHNATHAN THOMPSON | 844133541 - (MS) MITIAS ORTHOPAEDICS PLLC | GA | Orthopaedic Trauma Physician (207XX0801X) |
United | 97760 | $53.99 | 1598297988 - LUIS GUADA | 900603487 - (NY) PHYSICIAN AFFILIATE GROUP OF NEW YORK PC | FL | Neurological Surgery Physician (207T00000X) |
United | 97760 | $35.91 | 1710970322 - GARY ACKERMAN | 592686544 - (FL) PALM BEACH SPORTSMEDICINE & ORTHOPAEDIC CENTER, P.A. | FL | Sports Medicine (Orthopaedic Surgery) Physician (207XX0005X) |
United | 97760 | $29.52 | 1295027373 - JOSEPH M KUKLA DPM PA | 452119718 - (FL) JOSEPH M KUKLA DPM PA | FL | Foot & Ankle Surgery Podiatrist (213ES0103X) |
United | 97760 | $35.36 | 1710966361 - MARIA JARAMILLO-DOLAN | 593669428 - (FL) CENTRAL FLORIDA FOOT AND ANKLE CENTER, LLC | FL | Foot & Ankle Surgery Podiatrist (213ES0103X) |
United | 97760 | $45.02 | 1891359816 - KALE MEEKS | 593149293 - SOUTHWEST VOLUSIA HEALTHCARE CORPORATION | KS | Foot & Ankle Surgery Podiatrist (213ES0103X) |
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 97760 vs. Other Physical Medicine and Rehabilitation Evaluations Codes
The CPT 97760 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 97760 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 |
|---|---|---|
| 97545-CPT | Low | Work Hardening/Condit Initial 2 Hrs |
| 97546-CPT | Low | Work Hardening/Conditioning; Each Additional Hour (List Separately In Addition To Code For Primary Procedure) |
| 97750-CPT | Low | Physical Performance Test Or Measurement (Eg, Musculoskeletal, Functional Capacity), With Written Report, Each 15 Minutes |
| 97760-CPT | Low | Orthotic(S) Management And Training (Including Assessment And Fitting When Not Otherwise Reported) Upper Extremity(Ies) Lower Extremity(Ies) And/Or Trunk Initial Orthotic Encounter Each 15 Minutes (Desc Revised 1/1/2018) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 97760. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 97760 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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