How much does Medicare pay for CPT 97130?

Medicare allowed an average of $21.18 per service and paid $16.75 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $45.51, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 97130?

Therapy procedure for a range of mental processes, each additional 15 minutes. It was billed 496,028 times to 14,637 Medicare beneficiaries by 601 providers in 2024.

Does 97130 pay differently in an office than a hospital?

Yes. The allowed amount averaged $21.19 in an office setting and $20.87 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 97130 most?

Speech Language Pathologist, with 425,389 services from 521 clinicians. Next are Psychologist, Clinical, Family Practice, Occupational Therapist in Private Practice.

CPT 97130

Therapy procedure for a range of mental processes, each additional 15 minutes

$21.18Medicare-allowed amount per service, averaged across 496,028 services

Providers submitted

$45.51

Asking price, not received

Medicare allowed

$21.18

The fee schedule figure

Medicare paid

$16.75

Balance is patient coinsurance

Providers submitted an average of $45.51 for this code and Medicare allowed $21.18 — 2.1× 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 $16.75 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $21.19
Hospital / facility: $20.87

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. 486,540 services were billed in an office setting and 9,488 in a facility.

Services: 496,028
Beneficiaries: 14,637
Providers billing it: 601
Total allowed: $10,505,873

What Medicare pays for CPT 97130

Across 496,028 services billed by 601 providers to 14,637 beneficiaries, Medicare allowed an average of $21.18 per service. That is 33.9 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 97130

Specialty	Services	Beneficiaries	Avg allowed	Providers
Speech Language Pathologist	425,389	12,309	$21.12	521
Psychologist, Clinical	39,337	853	$22.33	13
Family Practice	14,692	218	$20.97	5
Occupational Therapist in Private Practice	7,528	782	$20.64	45
Nurse Practitioner	3,918	98	$17.88	3
Internal Medicine	2,612	72	$21.45	3
Neurology	1,335	111	$21.12	6
Physical Medicine and Rehabilitation	402	22	$20.95	1
Psychiatry	339	109	$23.17	1
Licensed Clinical Social Worker	278	33	$15.60	1
Osteopathic Manipulative Medicine	147	14	$21.01	1
Audiologist	51	16	$21.21	1

97130 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 Jersey	52,856	$22.44	$16.59	62
Pennsylvania	49,760	$21.22	$16.59	56
Florida	47,959	$21.19	$16.55	39
New York	43,981	$23.10	$16.55	43
Texas	28,682	$20.51	$16.25	28
South Carolina	25,197	$20.45	$16.50	25
Ohio	24,318	$20.47	$16.54	25
Illinois	15,964	$20.85	$16.46	29
Mississippi	14,197	$20.11	$16.65	10
Nevada	13,744	$20.60	$16.34	6
Georgia	12,519	$20.77	$16.40	18
California	12,031	$21.76	$16.28	34
Maryland	11,979	$21.64	$16.47	21
Missouri	11,365	$20.60	$16.54	16
Virginia	10,213	$20.83	$16.50	14
Oklahoma	10,157	$20.38	$16.57	7
Wisconsin	9,762	$20.45	$16.52	17
Indiana	9,715	$20.31	$16.39	11
Iowa	9,199	$20.38	$16.61	15
Kansas	9,060	$20.45	$16.52	10
Tennessee	7,180	$20.37	$16.41	9
Louisiana	6,719	$20.41	$16.58	5
Delaware	5,671	$21.39	$16.47	7
Michigan	5,649	$20.76	$16.60	6
Arizona	5,108	$20.44	$16.29	9
Colorado	5,059	$20.73	$16.50	10
Alabama	4,828	$20.15	$16.66	5
Washington	4,244	$21.65	$16.25	10
North Carolina	4,048	$21.11	$16.40	9
Massachusetts	3,507	$21.53	$16.57	4
Kentucky	2,886	$20.33	$16.60	4
West Virginia	2,722	$20.40	$16.51	3
New Hampshire	2,432	$22.14	$16.63	2
Utah	2,430	$20.09	$16.13	10
Arkansas	2,067	$20.09	$16.68	2
Rhode Island	1,775	$21.42	$16.55	3
Wyoming	1,743	$20.80	$16.08	4
Maine	863	$20.81	$16.03	2
Minnesota	847	$21.74	$16.52	3
Connecticut	829	$21.72	$16.36	1
South Dakota	761	$20.68	$15.58	1
Oregon	484	$20.72	$16.41	1
Idaho	375	$20.29	$16.42	1
Nebraska	366	$20.35	$16.70	1
Hawaii	344	$20.30	$15.74	1
District of Columbia	341	$21.71	$16.66	1
Montana	92	$20.93	$16.68	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
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.