CPT 97803 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 • Medical Nutrition Therapy Procedures |
| Common Place of Service | • 11 - Office • None • 10 - Telehealth in Patient's Home |
| Common Modifiers | • None • 95 - Telemedicine - audio and video • GT - Via interactive audio and video telecommunication systems |
| Complexity Level | Low |
National average reimbursement for CPT 97803 by major payers:
$34.89
$38.00
$48.63
$38.74
| 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 97803 | ||||||
United | 97803 | $68.93 | 1548767668 - SARAH GROUT | 842411303 | KY | Pediatrics Physician (208000000X) |
United | 97803 | $88.05 | 1770559411 - MATTHEW HAJDUK | 20509589 - ELLIOT PHYSICIANS NETWORK INC | NH | Pediatrics Physician (208000000X) |
United | 97803 | $49.91 | 1932831971 - KRISTEN EMODI | 470553011 - (NE) LINCOLN MEDICAL EDUCATION PARTNERSHIP | NE | Pediatrics Physician (208000000X) |
United | 97803 | $28.21 | 1235459694 - FOIQA CHAUDHRY | 760191917 - (TX) MEMORIAL ENDOCRINOLOGY AND DIABETES | OH | Endocrinology, Diabetes & Metabolism Physician (207RE0101X) |
United | 97803 | $38.27 | 1225211600 - JOHN MILLICHAP | 753186720 | CO | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 97803 | $33.79 | 1144459231 - DEBRA WRIGHT-BOWERS | 921338168 - (MI) QUADRANT MI VIRTUAL CARE PC | TX | Pediatrics Physician (208000000X) |
United | 97803 | $61.25 | 1851558001 - LUBOV ROMANTSEVA | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 97803 | $56.11 | 1942442355 - SUZANNE BAILEY | 930427496 - (OR) SALEM PEDIATRIC CLINIC, LLP | UT | Pediatrics Physician (208000000X) |
United | 97803 | $69.06 | 1225211600 - JOHN MILLICHAP | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | CO | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 97803 | $43.40 | 1720083892 - MATTHEW MASIELLO | 300716804 - (MA) PHYSICIANS OF FALMOUTH HOSPITAL | MA | Pediatrics Physician (208000000X) |
United | 97803 | $30.77 | 1932127545 - CHRISTOPHER TOLCHER | 330947157 - (CA) COASTAL KIDS, A PROFESSIONAL MED | CA | Pediatrics Physician (208000000X) |
United | 97803 | $69.06 | 1780976399 - ANNA JEONG | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 97803 | $31.80 | 1891113395 - BLAIR MURPHY-CHUTORIAN | 272000888 - (NY) MANHATTAN DERMATOLOGY | NY | Dermatology Physician (207N00000X) |
United | 97803 | $28.03 | 1548366263 - NARSIMHA MUDDASANI | 371305510 - TOUCHETTE REGIONAL HOSPITAL INC | IL | Psychiatry Physician (2084P0800X) |
United | 97803 | $28.54 | 1659397032 - JENNIFER KITCHIN | 900724520 - (NY) COSMETIC PHYSICIANS OF WESTCHESTER PLLC | NY | Dermatology Physician (207N00000X) |
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 97803 vs. Other Medical Nutrition Therapy Procedures Codes
The CPT 97803 code is part of the Medicine Services and Procedures services used for Medical Nutrition Therapy Procedures. 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 97803 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 |
|---|---|---|
| 97763-CPT | Low | Orthotic(S)/Prosthetic(S) Management And/Or Training Upper Extremity(Ies) Lower Extremity(Ies) And/Or Trunk Subsequent Orthotic(S)/Prosthetic(S) Encounter Each 15 Minutes |
| 97802-CPT | Low | Medical Nutrition Therapy; Initial Assessment And Intervention, Individual, Face-To-Face With The Patient, Each 15 Minutes |
| 97803-CPT | Low | Medical Nutrition Therapy; Re-Assessment And Intervention, Individual, Face-To-Face With The Patient, Each 15 Minutes |
| 97804-CPT | Low | Medical Nutrition Therapy; Group (2 Or More Individuals), Each 30 Minutes |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 97803. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 97803 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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