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See a sample rate comparisonCPT 97810 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.
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
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Acupuncture Procedures |
| Common Place of Service | 11 - Office 50 - Federally Qualified Health Center |
| Common Modifiers | 59 - Distinct Procedural Service GY - Notice of Liability Not Issued, Not Required Under Payer Policy. |
| Complexity Level | Low |
| Medicare Fee Schedule | $48.10 national non-facility rate (2026) · View Medicare rates for 97810 |
| Medicaid Fee Schedule | $29.095 median of the 6 states in the free preview · View Medicaid rates for 97810 |
National average reimbursement for CPT 97810 by major payers:
$43.39
$46.85
$47.33
$67.53
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CPT 97810
5 of 25 sample ratesHigher to lower in this preview
Asifa Choudhry
Carle West Physician Group Inc
$109.23Published rateTushar Advani
Loyola University Medical Center
$71.50Published rateMatthew Filippo
Advocate Health And Hospitals Corporation
$63.08Published rateJennifer Harkey
Northwestern Memorial Healthcare
$56.81Published rateSunrise Home Health Care Inc.
Sunrise Home Health Care Inc
$13.03Published rate
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See a sample payer proposalCPT 97810 vs. Other Acupuncture Procedures Codes
The CPT 97810 code is part of the Medicine Services and Procedures services used for Acupuncture 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 97810 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 |
|---|---|---|
| 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 |
| 97811-CPT | Low | Acupunct W O Stimul Addl 15m, Acupuncture 1 Or More Needles Without Electrical Stimulation Each Additional 15 Minutes Of Personal One On One Contact With The Patient With Re Insertion Of Needle S List Separately In Addition To Code For Primary Procedure |
| 97813-CPT | Low | Acupuncture With Stimulation, Acupuncture Services Provided In 15-Minute Increments. Includes Electrical Stimulation Of The Acupuncture Points After Needles Are Inserted. |
| 97814-CPT | Low | Acupunct W Stimul Addl 15m, Acupuncture 1 Or More Needles With Electrical Stimulation Each Additional 15 Minutes Of Personal One On One Contact With The Patient With Re Insertion Of Needle S List Separately In Addition To Code For Primary Procedure |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 97810. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 97810 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
To get an estimate for a medical procedure or service, begin by contacting your healthcare provider's billing department; they can often provide an estimated cost. It is also crucial to contact your health insurance company to understand what portion they will cover and what your out-of-pocket responsibility might be, taking into account your deductible, copay, and coinsurance. For a more detailed lookup of potential costs based on CPT codes and your specific location, you can utilize tools like Payerprice, which offers a fee schedule lookup tool to help you compare prices.
CPT stands for Current Procedural Terminology. CPT codes are standardized numerical codes used by healthcare providers to describe the medical, surgical, and diagnostic services they provide to patients. These codes are essential for billing and for your insurance company to process claims. Each CPT code corresponds to a specific service, and the cost of that service is often tied directly to its CPT code. When you see a medical bill or are looking for cost estimates, CPT codes help specify exactly what services were performed or are being quoted.
For looking up fee schedules for specific CPT codes in your area, it's recommended to use specialized tools designed for price transparency. You can use Payerprice, which provides a fee schedule lookup tool where you can search by CPT code and your specific location to find pricing information. This can give you an idea of what providers charge for certain services, helping you to make more informed decisions about your healthcare.
Estimating out-of-pocket costs with a high deductible involves a few steps. First, contact your insurance company to understand how much of your deductible you have met and what percentage of the cost they will cover after the deductible is met. Next, ask your healthcare provider for a good faith estimate of the total cost for the procedure, ensuring they provide the CPT codes involved. Finally, to compare prices and get a better understanding of what different providers might charge for the same service in your location, you can use Payerprice's fee schedule lookup tool with the relevant CPT codes.
If you receive a medical bill that seems too high or incorrect, the first step is to carefully review every item on the bill against your Explanation of Benefits (EOB) from your insurance company. Look for any unfamiliar charges, duplicate services, or incorrect CPT codes. Next, contact the healthcare provider's billing department to ask for an itemized bill and an explanation of the charges. Don't hesitate to negotiate the price if it seems unreasonable; many providers are willing to work with patients. For comparison, you can use Payerprice to research the typical costs for the CPT codes listed on your bill in your geographic area, which can provide leverage in your discussions.