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See a sample rate comparisonCPT 97761 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.
Prosthetic Traing 1st Enc, Prosthetic S Training Upper And Or Lower Extremity Ies Initial Prosthetic S Encounter Each 15 Minutes
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Physical Medicine and Rehabilitation Evaluations |
| Common Place of Service | 11 - Office 49 - Independent Clinic |
| Common Modifiers | GP - Services delivered under an outpatient physical therapy plan of care KX - Requirements specified in the medical policy have been met |
| Complexity Level | Low |
| Medicare Fee Schedule | $40.42 national non-facility rate (2026) · View Medicare rates for 97761 |
| Medicaid Fee Schedule | $32.74 median of the 7 states in the free preview · View Medicaid rates for 97761 |
National average reimbursement for CPT 97761 by major payers:
$42.02
$38.19
$35.00
$49.28
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CPT 97761
5 of 25 sample ratesHigher to lower in this preview
Adam Wallace
Aurora Medical Group Inc
$144.27Published rateNeil Jariwala
$82.83Published rateMohammad Ikramuddin
Advocate Health And Hospitals Corporation
$67.87Published rateAnoop Vermani
Northwestern Memorial Healthcare
$38.00Published rateChristopher Johnson
Southern Illinois Healthcare Foundation Inc
$22.54Published rate
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See a sample payer proposalCPT 97761 vs. Other Physical Medicine and Rehabilitation Evaluations Codes
The CPT 97761 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 97761 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 Hardeningconditioning E, Work Hardeningconditioning Each Additional Hour (Listseparately In Addition To Code For Primary Procedure) Work Hardeningconditioning Each Additional Hour (List |
| 97755-CPT | Low | Assistive Technology Assess, 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 |
| 97761-CPT | Low | Prosthetic Traing 1st Enc, Prosthetic S Training Upper And Or Lower Extremity Ies Initial Prosthetic S Encounter Each 15 Minutes |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 97761. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 97761 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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