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See a sample rate comparisonCPT 97813 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.
Acupuncture With Stimulation, Acupuncture Services Provided In 15-Minute Increments. Includes Electrical Stimulation Of The Acupuncture Points After Needles Are Inserted.
| 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 GP - Services delivered under an outpatient physical therapy plan of care |
| Complexity Level | Low |
| Medicare Fee Schedule | $56.45 national non-facility rate (2026) · View Medicare rates for 97813 |
| Medicaid Fee Schedule | $32.77 median of the 7 states in the free preview · View Medicaid rates for 97813 |
National average reimbursement for CPT 97813 by major payers:
$49.35
$51.36
$52.59
$75.51
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CPT 97813
5 of 25 sample ratesHigher to lower in this preview
Srishti Nangia
$134.96Published rateLaura Vernon
Pediatric Faculty Foundation In
$84.25Published rateSyed Khan
Loyola University Medical Center
$79.40Published rateAndrei Pankov
$63.40Published rateAll Ways Homecare Inc
$35.00Published rate
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See a sample payer proposalCPT 97813 vs. Other Acupuncture Procedures Codes
The CPT 97813 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 97813 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 97813. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 97813 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 find out the cost of a medical procedure or service beforehand, you can contact your insurance provider to inquire about your coverage and estimated out-of-pocket costs. For a more direct way to look up specific prices based on CPT codes and your location, you can utilize tools like Payerprice. Payerprice offers a fee schedule lookup tool where you can search with a CPT code and specific location to get an idea of the costs.
Healthcare costs can vary significantly for the same service due to several factors, including the type of facility (hospital vs. outpatient clinic), geographical location, the specific insurance plan and negotiated rates, the provider's reputation, and whether the service is in-network or out-of-network. Different providers and insurers have varying contracts and pricing structures, leading to a wide range of prices even for identical procedures.
CPT stands for Current Procedural Terminology. CPT codes are a set of medical codes used by healthcare professionals to report medical, surgical, and diagnostic procedures and services to entities like physicians, health insurance companies, and accreditation organizations. Each CPT code corresponds to a specific service or procedure, allowing for standardized communication and billing across the healthcare system. When you receive a medical bill, these codes help justify the charges for the services rendered.
If you believe your medical bill is too high or incorrect, you should first review the itemized bill carefully and compare it with the services you received. Then, contact the provider's billing department to ask for clarification or dispute specific charges. You can also reach out to your insurance company to understand what they covered and why. For specific price comparisons based on CPT codes and your location, you can use Payerprice's fee schedule lookup tool to research typical costs for those services.
A fee schedule in healthcare is a comprehensive listing of fees used by healthcare providers and insurance companies to determine reimbursement for medical services. It specifies the maximum amount that will be paid for a particular service or procedure, often identified by CPT codes. Fee schedules can vary greatly between different insurance companies, regions, and even types of providers. Understanding a fee schedule can help patients anticipate costs and verify the fairness of charges. Tools like Payerprice provide access to fee schedule information for various services based on CPT codes and location.