CPT 97813 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 • 50 - Federally Qualified Health Center |
| Common Modifiers | • None • 59 - Distinct Procedural Service • GP - Services delivered under an outpatient physical therapy plan of care |
| Complexity Level | Low |
National average reimbursement for CPT 97813 by major payers:
$49.35
$51.36
$52.59
$76.57
| 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 97813 | ||||||
United | 97813 | $74.06 | 1205831393 - PRITI SINGH | 461302245 - (IL) ASSOCIATES IN PEDIATRIC NEUROLOGY SC | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 97813 | $45.61 | 1134741028 - SHAHZAIB KHAN | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 97813 | $63.40 | 1225285703 - ANDREI PANKOV | 320552496 | IL | Psychiatry Physician (2084P0800X) |
United | 97813 | $80.77 | 1841571841 - OMOTOLA AJIBADE | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Psychiatry Physician (2084P0800X) |
United | 97813 | $52.77 | 1225211600 - JOHN MILLICHAP | 753186720 | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 97813 | $35.00 | 1588756076 - ALL WAYS HOMECARE INC | 202696236 | FL | Home Health Agency (251E00000X) |
United | 97813 | $84.25 | 1558650614 - TRACY GERTLER | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 97813 | $84.25 | 1578957676 - LAURA VERNON | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 97813 | $81.41 | 1710206545 - NEIL JARIWALA | 910844563 | GA | Psychiatry Physician (2084P0800X) |
United | 97813 | $85.59 | 1285715847 - SHANNON JENNINGS | 362604009 - (IL) OTTAWA REGIONAL HOSPITAL & HEALTHCARE CENTER | MO | Psychiatry Physician (2084P0800X) |
United | 97813 | $79.40 | 1407807746 - SYED KHAN | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IN | Psychiatry Physician (2084P0800X) |
United | 97813 | $71.87 | 1972984169 - DAVID SHOLTES | 911780160 | IL | Psychiatry Physician (2084P0800X) |
United | 97813 | $134.96 | 1790936540 - SRISHTI NANGIA | 131623978 | NY | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 97813 | $94.98 | 1851558001 - LUBOV ROMANTSEVA | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 97813 | $59.49 | 1871505230 - MICHAEL NAYLOR | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
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 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 |
|---|---|---|
| 97763-CPT | Low | Orthotic(S)/Prosthetic(S) Management And/Or Training Upper Extremity(Ies) Lower Extremity(Ies) And/Or Trunk Subsequent Orthotic(S)/Prosthetic(S) Encounter 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 |
| 97813-CPT | Low | Acupuncture, 1 Or More Needles; With 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 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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