CPT 97113

Across 1,308,737 services billed by 2,031 providers to 63,053 beneficiaries, Medicare allowed an average of $27.67 per service. That is 20.8 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.

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.

• 97110Therapy procedure$22.78
• 97112Therapy procedure to re-educate brain-to-nerve-to-muscle function$27.06
• 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
• 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

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.

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