How much does Medicare pay for CPT 97112?

Medicare allowed an average of $27.06 per service and paid $20.91 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $72.66, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 97112?

Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes. It was billed 33,792,592 times to 3,542,214 Medicare beneficiaries by 67,834 providers in 2024.

Does 97112 pay differently in an office than a hospital?

Yes. The allowed amount averaged $27.06 in an office setting and $28.81 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 97112 most?

Physical Therapist in Private Practice, with 31,397,523 services from 61,867 clinicians. Next are Occupational Therapist in Private Practice, Orthopedic Surgery, Nurse Practitioner.

CPT 97112

Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes

$27.06Medicare-allowed amount per service, averaged across 33,792,592 services

Providers submitted

$72.66

Asking price, not received

Medicare allowed

$27.06

The fee schedule figure

Medicare paid

$20.91

Balance is patient coinsurance

Providers submitted an average of $72.66 for this code and Medicare allowed $27.06 — 2.7× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $20.91 (77%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $27.06
Hospital / facility: $28.81

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 33,792,179 services were billed in an office setting and 413 in a facility.

Services: 33,792,592
Beneficiaries: 3,542,214
Providers billing it: 67,834
Total allowed: $914,427,540

What Medicare pays for CPT 97112

Across 33,792,592 services billed by 67,834 providers to 3,542,214 beneficiaries, Medicare allowed an average of $27.06 per service. That is 9.5 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 97112

Specialty	Services	Beneficiaries	Avg allowed	Providers
Physical Therapist in Private Practice	31,397,523	3,329,905	$27.09	61,867
Occupational Therapist in Private Practice	1,969,326	159,704	$26.41	4,971
Orthopedic Surgery	79,776	18,385	$28.33	282
Nurse Practitioner	79,129	5,193	$24.39	106
Physical Medicine and Rehabilitation	79,093	9,063	$28.54	186
Family Practice	34,654	3,618	$28.78	64
Anesthesiology	22,368	826	$28.26	12
Internal Medicine	21,374	2,147	$29.34	47
Podiatry	14,025	1,391	$30.43	26
Neurology	13,327	1,254	$27.61	36
Physician Assistant	12,195	1,539	$26.13	27
Emergency Medicine	12,133	661	$31.24	8
Otolaryngology	10,615	2,015	$25.10	49
Pain Management	6,738	492	$28.95	16
General Practice	5,872	917	$30.25	7

97112 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
New York	3,499,899	$29.95	$21.20	5,659
California	3,304,700	$28.97	$20.57	5,561
New Jersey	2,305,516	$29.29	$21.06	3,811
Florida	2,084,261	$25.94	$20.04	3,005
Texas	1,779,174	$25.81	$20.21	3,275
Illinois	1,701,719	$26.55	$20.18	3,612
Pennsylvania	1,694,734	$26.80	$20.65	2,758
Virginia	1,205,970	$26.48	$20.24	2,126
Maryland	1,084,057	$27.81	$20.45	2,031
Arizona	946,730	$25.65	$20.04	1,821
Michigan	894,602	$26.16	$20.37	2,213
Georgia	828,589	$25.58	$20.22	1,819
North Carolina	819,379	$25.74	$20.29	2,114
Massachusetts	762,712	$28.83	$21.04	1,827
Ohio	693,913	$25.51	$20.25	1,505
Colorado	672,924	$27.22	$20.51	1,711
Washington	652,394	$27.04	$19.97	2,108
Tennessee	562,018	$24.69	$19.95	1,369
Indiana	498,298	$25.23	$20.03	1,229
South Carolina	489,457	$25.06	$20.08	1,023
Missouri	486,178	$24.90	$19.84	1,047
Louisiana	453,745	$25.34	$20.57	807
Alabama	447,679	$24.32	$19.99	1,053
Oklahoma	393,685	$24.10	$19.63	557
Connecticut	356,633	$28.91	$21.27	866
Iowa	349,218	$25.64	$20.51	934
Wisconsin	339,264	$26.16	$20.49	1,134
Kentucky	334,077	$24.64	$19.96	829
Delaware	319,475	$26.11	$20.08	476
Mississippi	311,500	$24.49	$20.28	539
Nebraska	291,545	$25.29	$20.22	584
Kansas	278,836	$25.20	$20.26	650
Nevada	262,478	$26.52	$20.65	510
Oregon	254,110	$26.15	$19.94	868
Minnesota	240,926	$27.31	$20.90	1,124
Utah	233,778	$26.30	$20.89	600
Arkansas	221,292	$24.44	$20.44	469
Idaho	212,666	$25.31	$20.25	495
Montana	173,187	$26.71	$20.55	416
West Virginia	169,517	$24.91	$20.17	321
New Mexico	166,234	$24.98	$19.80	299
New Hampshire	155,018	$27.31	$20.87	347
Wyoming	152,288	$27.11	$20.88	279
Rhode Island	135,841	$27.09	$20.16	379
Maine	121,005	$26.90	$20.97	374
Hawaii	94,135	$28.38	$20.93	294
South Dakota	82,181	$26.75	$20.69	218
Alaska	82,118	$34.42	$20.76	239
District of Columbia	64,020	$29.18	$20.81	151
Vermont	58,512	$27.14	$20.69	170
North Dakota	55,551	$27.24	$21.11	175
U.S. Virgin Islands	6,979	$26.46	$20.59	14
Puerto Rico	3,044	$26.30	$20.63	18
XX	1,939	$28.31	$22.58	2
AE	1,103	$28.06	$21.57	4
ZZ	642	$25.86	$19.91	4

Related codes

97110Therapy procedure$22.78
97140Therapy procedure$20.62
97116Therapy procedure for walking training$21.87
97150Therapy procedure in a group setting$13.60
97161Evaluation for physical therapy$99.49
97162Evaluation for physical therapy$99.21
97113Therapy procedure$27.67
97130Therapy procedure for a range of mental processes$21.18
97164Re-evaluation for physical therapy$68.54
97124Therapy procedure$25.23
97129Therapy procedure for a range of mental processes$21.82
97163Evaluation for physical therapy$99.08

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.