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See a sample rate comparisonCPT 97811 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 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
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Acupuncture Procedures |
| Common Place of Service | 11 - Office 19 - Off Campus Outpatient Hospital |
| Common Modifiers | 59 - Distinct Procedural Service GY - Notice of Liability Not Issued, Not Required Under Payer Policy. |
| Complexity Level | Low |
| Medicare Fee Schedule | $28.39 national non-facility rate (2026) · View Medicare rates for 97811 |
| Medicaid Fee Schedule | $21.35 median of the 7 states in the free preview · View Medicaid rates for 97811 |
National average reimbursement for CPT 97811 by major payers:
$33.09
$35.69
$34.96
$50.84
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CPT 97811
5 of 25 sample ratesHigher to lower in this preview
Mark Wainwright
The Association Of Chrmc And University Physicians
$73.47Published rateDavid Banayan
Loyola University Medical Center
$56.02Published rateSuraya Kawadry
Loyola University Medical Center
$46.45Published rateJohn Millichap
$40.61Published rateAndrew Kulik
Saint Anthony Health Affiliates
$24.80Published rate
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See a sample payer proposalCPT 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 |
|---|---|---|
| 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 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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Frequently Asked Questions
Finding the exact cost of a medical procedure beforehand can be challenging as prices vary based on the provider, location, and your insurance plan. However, tools like Payerprice offer fee schedule lookup features that allow you to search for estimated costs using CPT codes and your specific location, providing a useful starting point for understanding potential expenses.
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 and procedures they provide to patients. They are essential for accurate billing and are often used by insurance companies and pricing tools, like Payerprice, to determine reimbursement rates and estimated costs for specific services.
A fee schedule is a comprehensive listing of fees used by health insurers to pay providers for services, or by providers to set their charges. It dictates the maximum amount an insurer will reimburse for specific medical services or procedures, often identified by CPT codes. Understanding fee schedules can help consumers anticipate potential costs.
To find specific pricing for a medical service based on your location, you can utilize online tools designed for this purpose. Payerprice offers a fee schedule lookup tool where you can search for estimated costs using a CPT code and your specific geographical area, helping you compare potential prices for various procedures.
Yes, your insurance plan significantly affects the price you ultimately pay for a procedure. While tools like Payerprice can provide estimated fee schedule information, your out-of-pocket cost will depend on your specific plan's deductible, co-insurance, co-payments, and whether the provider is in-network or out-of-network. Always confirm your coverage with your insurance provider.
The billed charge is the amount a healthcare provider initially charges for a service. This is often higher than what an insurance company (or Payerprice's fee schedule) considers the 'allowed amount' or 'negotiated rate' for that service. What you actually pay, your out-of-pocket cost, is determined by your insurance plan's benefits after the allowed amount is applied, factoring in deductibles, co-pays, and co-insurance.
While the Centers for Medicare & Medicaid Services (CMS) provides a wealth of information regarding Medicare services and reimbursement, for general users looking to research specific procedure costs based on CPT codes and location, it is recommended to use dedicated tools. Payerprice offers a user-friendly fee schedule lookup tool that allows you to search for estimated costs with CPT codes and specific locations, which can be more directly applicable for a broader range of insurance and self-pay scenarios.