How much does Medicare pay for CPT 97129?

Medicare allowed an average of $21.82 per service and paid $17.21 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $52.40, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 97129?

Therapy procedure for a range of mental processes, initial 15 minutes. It was billed 262,490 times to 23,252 Medicare beneficiaries by 854 providers in 2024.

Does 97129 pay differently in an office than a hospital?

Yes. The allowed amount averaged $21.82 in an office setting and $21.79 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 97129 most?

Speech Language Pathologist, with 175,080 services from 538 clinicians. Next are Nurse Practitioner, Occupational Therapist in Private Practice, Psychologist, Clinical.

CPT 97129

Therapy procedure for a range of mental processes, initial 15 minutes

$21.82Medicare-allowed amount per service, averaged across 262,490 services

Providers submitted

$52.40

Asking price, not received

Medicare allowed

$21.82

The fee schedule figure

Medicare paid

$17.21

Balance is patient coinsurance

Providers submitted an average of $52.40 for this code and Medicare allowed $21.82 — 2.4× 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 $17.21 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $21.82
Hospital / facility: $21.79

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 260,042 services were billed in an office setting and 2,448 in a facility.

Services: 262,490
Beneficiaries: 23,252
Providers billing it: 854
Total allowed: $5,727,532

What Medicare pays for CPT 97129

Across 262,490 services billed by 854 providers to 23,252 beneficiaries, Medicare allowed an average of $21.82 per service. That is 11.3 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 97129

Specialty	Services	Beneficiaries	Avg allowed	Providers
Speech Language Pathologist	175,080	12,861	$22.14	538
Nurse Practitioner	32,087	2,050	$19.61	64
Occupational Therapist in Private Practice	24,226	2,863	$21.63	155
Psychologist, Clinical	12,061	968	$23.16	16
Family Practice	7,139	1,074	$22.08	14
Physician Assistant	3,784	324	$20.58	12
Internal Medicine	3,084	1,838	$23.72	16
Physical Therapist in Private Practice	1,216	252	$20.72	9
Psychiatry	932	144	$22.91	3
Neuropsychiatry	888	60	$22.20	2
Neurology	690	227	$22.10	8
Pulmonary Disease	532	446	$21.91	11
Physical Medicine and Rehabilitation	403	22	$22.01	1
Osteopathic Manipulative Medicine	146	14	$22.02	1
Licensed Clinical Social Worker	142	33	$16.34	1

97129 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
California	38,617	$20.99	$15.42	128
New Jersey	23,530	$23.46	$17.35	84
Pennsylvania	21,764	$22.27	$17.35	60
Florida	20,056	$21.92	$17.15	51
New York	19,198	$23.98	$17.13	56
Nevada	12,168	$20.02	$15.91	18
Texas	11,254	$21.44	$16.92	36
South Carolina	9,816	$21.41	$17.26	26
Ohio	9,609	$21.41	$17.29	28
Illinois	8,417	$21.75	$17.13	36
Missouri	6,233	$20.96	$16.97	21
Georgia	6,111	$21.72	$16.80	20
Maryland	6,036	$22.54	$17.15	22
Mississippi	5,808	$21.05	$17.42	10
Virginia	5,649	$21.58	$16.91	29
Oklahoma	4,362	$21.32	$17.35	8
Wisconsin	4,333	$21.32	$17.20	19
Iowa	4,129	$21.34	$17.39	16
Kansas	3,727	$21.38	$17.24	11
Indiana	3,632	$21.28	$17.18	11
Tennessee	3,573	$21.31	$17.20	11
Colorado	3,370	$21.68	$16.86	21
North Carolina	3,217	$21.58	$16.98	15
Washington	2,682	$22.63	$16.90	11
Michigan	2,595	$21.50	$17.10	10
Delaware	2,565	$22.45	$17.24	8
Arizona	2,476	$21.22	$16.86	15
Louisiana	2,452	$21.34	$17.35	5
Utah	1,999	$20.27	$16.30	15
Alabama	1,858	$21.09	$17.44	6
Massachusetts	1,482	$22.51	$17.11	5
West Virginia	1,412	$21.34	$17.25	3
Kentucky	1,408	$21.22	$17.32	5
New Hampshire	982	$23.21	$17.36	3
Wyoming	900	$21.82	$17.00	4
Maine	865	$20.37	$15.68	3
Arkansas	800	$21.01	$17.42	2
Rhode Island	705	$22.30	$17.22	3
Idaho	527	$21.24	$17.26	1
Minnesota	457	$22.22	$17.33	3
Connecticut	370	$22.73	$17.03	2
Oregon	339	$21.49	$16.40	3
South Dakota	267	$21.66	$16.20	3
District of Columbia	206	$22.60	$17.23	2
Nebraska	204	$21.30	$17.49	1
Montana	172	$21.47	$17.02	2
Hawaii	112	$21.25	$16.29	1
North Dakota	46	$21.74	$17.45	1

Related codes

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
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
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.