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See a sample rate comparisonCPT 97804 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.
Medic Nutrition Therap; Group (2 Or More Individ(S)) Ea 30 Mi, Medical Nutrition Therapy; Group (2 Or More Individual(S)) Each 30 Mi
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Medical Nutrition Therapy Procedures |
| Common Place of Service | 11 - Office |
| Common Modifiers | 95 - Telemedicine - audio and video GT - Via interactive audio and video telecommunication systems |
| Complexity Level | Low |
| Medicare Fee Schedule | $17.03 national non-facility rate (2026) · View Medicare rates for 97804 |
| Medicaid Fee Schedule | $13.54 median of the 8 states in the free preview · View Medicaid rates for 97804 |
National average reimbursement for CPT 97804 by major payers:
$19.41
$19.75
$25.28
$20.49
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CPT 97804
5 of 25 sample ratesHigher to lower in this preview
Anahid Edjlali
Association Of University Physicians
$35.61Published rateAudra Wilson
Alter Clinical Services LLC
$17.13Published rateAudra Wilson
Advanced Surgical Care Of Northern Illinois, Ltd.
$16.05Published rateEmiliya Subev
Medical Nutritional Therapy
$13.47Published rateSouth Florida Nuclear Medicine PA, North Miami Nuclear Medicine
South Florida Nuclear Medicine
$5.23Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 97804 vs. Other Medical Nutrition Therapy Procedures Codes
The CPT 97804 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 97804 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 |
|---|---|---|
| 97802-CPT | Low | Diet And Nutrition Counseling, Each 15 Minutes Of Individual Nutrition Therapy. Covers Assessment Plan Development And In-Person Meeting With Therapist. |
| 97803-CPT | Low | Diet And Nutrition Counseling, Each 15 Minutes Of Individual Nutrition Therapy. Covers Assessment Plan Development And In-Person Meeting With Therapist. |
| 97804-CPT | Low | Medic Nutrition Therap; Group (2 Or More Individ(S)) Ea 30 Mi, Medical Nutrition Therapy; Group (2 Or More Individual(S)) Each 30 Mi |
| 97810-CPT | Low | Acupunct W O Stimul 15 Min, Acupuncture 1 Or More Needles Without Electrical Stimulation Initial 15 Minutes Of Personal One On One Contact With The Patient |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 97804. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 97804 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
CPT stands for Current Procedural Terminology. CPT codes are a set of medical codes used by physicians, hospitals, and other healthcare providers to describe the services they provide to patients. These codes are used for billing and to track healthcare services.
To find out the cost of a specific medical procedure, you can take several steps. First, contact your insurance company directly, as they can provide an estimate based on your specific plan benefits. You can also ask your healthcare provider for a good faith estimate. For a fee schedule lookup tool to search with a CPT code and specific location, you can check resources like Payerprice.
A deductible is the amount of money you must pay out of your own pocket for healthcare services before your insurance company begins to pay. For example, if your deductible is $1,000, you'll pay the first $1,000 of covered services yourself before your insurance starts contributing.
Coinsurance is your share of the cost for a covered healthcare service, calculated as a percentage of the allowed amount for the service. You pay coinsurance after you've met your deductible. For example, if your plan pays 80% of the cost, your coinsurance is 20%.
A copayment, or copay, is a fixed amount you pay for a covered healthcare service, usually when you receive the service. For example, you might pay a $30 copay for a doctor's visit, and your insurance covers the rest of the allowed amount after any deductible.
Medical bills can seem complicated due to several factors, including the intricate coding system (like CPT and ICD-10 codes), the involvement of multiple parties (providers, hospitals, labs, insurance companies), and varying payment structures (deductibles, copays, coinsurance, in-network vs. out-of-network). Healthcare pricing is also not always transparent, making it hard to understand the final charges.
Yes, in many cases, you can negotiate your medical bill. It's often worth trying, especially if you are uninsured, have a high deductible, or received out-of-network care. You can contact the hospital or provider's billing department to discuss options like payment plans, discounts for prompt payment, or financial assistance programs.
If you need help understanding your medical bill or EOB, you can contact your insurance company directly using the member services number on your insurance card. You can also reach out to the hospital or provider's billing department. Additionally, there are independent patient advocates or financial counseling services that specialize in navigating healthcare costs and billing.