CPT 97811 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 • Acupuncture Procedures |
| Common Place of Service | • 11 - Office • 19 - Off Campus Outpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • GY - Notice of Liability Not Issued, Not Required Under Payer Policy. |
| Complexity Level | Low |
National average reimbursement for CPT 97811 by major payers:
$33.09
$35.69
$34.96
$53.47
| 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 97811 | ||||||
United | 97811 | $55.52 | 1447365440 - AYAME TAKAHASHI | 364143823 - SIU PHYSICIANS & SURGEONS INC | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 97811 | $35.00 | 1801164967 - DA PEDIATRIC REHABILITATION | 270939565 - (FL) DA PEDIATRIC REHABILITATION | FL | Home Health Agency (251E00000X) |
United | 97811 | $46.45 | 1710206545 - NEIL JARIWALA | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | TX | Psychiatry Physician (2084P0800X) |
United | 97811 | $51.36 | 1871592881 - CHANDRAGUPTA VEDAK | 363994258 - (IL) HORIZONS BEHAVIORAL HEALTH LLC | IL | Psychiatry Physician (2084P0800X) |
United | 97811 | $46.45 | 1366883555 - DAVID BANAYAN | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Psychiatry Physician (2084P0800X) |
United | 97811 | $37.20 | 1609883347 - BRAD BERGER | 362709982 - (IL) PRESENCE BEHAVIORAL HEALTH | MS | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 97811 | $46.45 | 1710206545 - NEIL JARIWALA | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IN | Psychiatry Physician (2084P0800X) |
United | 97811 | $46.45 | 1962664789 - JAMIE EVANS | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | WI | Psychiatry Physician (2084P0800X) |
United | 97811 | $27.51 | 1790057420 - BAMA HEART DOC, P.C., ALABAMA HEART AND VASCULAR MEDICINE | 451471722 - (AL) BAMA HEART DOC, PC DBA ALABAMA HEART & VASCULAR MEDICINE | AL | Interventional Cardiology Physician (207RI0011X) |
United | 97811 | $56.02 | 1407807746 - SYED KHAN | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IN | Psychiatry Physician (2084P0800X) |
United | 97811 | $41.70 | 1760923916 - LUKE PETRY | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Psychiatry Physician (2084P0800X) |
United | 97811 | $53.65 | 1205213261 - TAMAR CACERES | 911780160 | IL | Neurodevelopmental Disabilities Physician (2084P0005X) |
United | 97811 | $33.34 | 1275564197 - PAUL BERKOWITZ | 842494027 - BRIGHTSIDE MEDICAL | FL | Psychiatry Physician (2084P0800X) |
United | 97811 | $55.27 | 1891921367 - KAVITA THAKKAR | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | PA | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 97811 | $43.75 | 1497198832 - GABRIEL FUQUA | 363149833 - NORTHWESTERN MEMORIAL HEALTHCARE | IL | Psychiatry Physician (2084P0800X) |
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 97811 vs. Other Acupuncture Procedures Codes
The CPT 97811 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 97811 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 | Medical Nutrition Therapy; Initial 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 |
| 97810-CPT | Low | Acupuncture, 1 Or More Needles; Without Electrical Stimulation, Initial 15 Minutes Of Personal One-On-One Contact With The Patient |
| 97811-CPT | Low | 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) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 97811. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 97811 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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