How much does Medicare pay for CPT 97150?

Medicare allowed an average of $13.60 per service and paid $10.54 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $51.49, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 97150?

Therapy procedure in a group setting. It was billed 2,656,691 times to 521,848 Medicare beneficiaries by 10,254 providers in 2024.

Does 97150 pay differently in an office than a hospital?

Yes. The allowed amount averaged $13.60 in an office setting and $17.94 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 97150 most?

Physical Therapist in Private Practice, with 2,549,641 services from 9,679 clinicians. Next are Occupational Therapist in Private Practice, Orthopedic Surgery, Nurse Practitioner.

CPT 97150

Therapy procedure in a group setting

$13.60Medicare-allowed amount per service, averaged across 2,656,691 services

Providers submitted

$51.49

Asking price, not received

Medicare allowed

$13.60

The fee schedule figure

Medicare paid

$10.54

Balance is patient coinsurance

Providers submitted an average of $51.49 for this code and Medicare allowed $13.60 — 3.8× 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 $10.54 (77%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $13.60
Hospital / facility: $17.94

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 2,655,753 services were billed in an office setting and 938 in a facility.

Services: 2,656,691
Beneficiaries: 521,848
Providers billing it: 10,254
Total allowed: $36,130,998

What Medicare pays for CPT 97150

Across 2,656,691 services billed by 10,254 providers to 521,848 beneficiaries, Medicare allowed an average of $13.60 per service. That is 5.1 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 97150

Specialty	Services	Beneficiaries	Avg allowed	Providers
Physical Therapist in Private Practice	2,549,641	501,406	$13.59	9,679
Occupational Therapist in Private Practice	75,832	15,750	$14.18	469
Orthopedic Surgery	16,629	2,658	$13.77	55
Nurse Practitioner	8,626	738	$13.46	12
Physical Medicine and Rehabilitation	2,867	694	$13.95	19
Sports Medicine	723	100	$14.55	2
Neurology	695	185	$13.89	6
Podiatry	657	69	$13.86	3
Physician Assistant	394	73	$15.51	2
Interventional Pain Management	214	33	$13.51	2
Pain Management	177	31	$14.09	1
Family Practice	98	32	$11.98	2
Hand Surgery	83	66	$13.17	1
Anesthesiology	55	13	$13.72	1

97150 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
Pennsylvania	322,669	$13.72	$10.48	981
Texas	223,884	$13.15	$10.26	866
New Jersey	211,983	$14.58	$10.56	661
California	200,190	$14.21	$10.39	714
Maryland	145,765	$13.92	$10.25	408
Virginia	145,076	$13.67	$10.38	467
Georgia	134,275	$13.25	$10.42	595
New York	133,929	$14.90	$10.55	452
Arizona	127,095	$13.28	$10.43	422
Tennessee	112,457	$12.83	$10.32	570
Florida	98,961	$13.39	$10.34	316
South Carolina	69,824	$12.89	$10.35	271
Massachusetts	67,136	$13.73	$10.11	239
Oklahoma	56,868	$12.72	$10.21	122
Kentucky	52,994	$12.93	$10.42	266
North Carolina	52,780	$13.09	$10.39	304
Delaware	49,502	$13.50	$10.47	127
Ohio	43,823	$12.90	$10.22	292
Colorado	37,573	$13.76	$10.58	202
Nevada	33,898	$13.25	$10.21	137
Missouri	31,660	$13.10	$10.63	157
Illinois	29,051	$13.60	$10.43	156
Connecticut	28,864	$13.99	$10.33	110
Michigan	26,050	$13.54	$10.48	249
Alabama	25,912	$12.72	$10.28	166
Mississippi	25,638	$12.65	$10.30	118
Louisiana	22,962	$12.97	$10.50	122
Kansas	19,407	$13.07	$10.77	69
Indiana	16,466	$12.98	$10.38	89
Washington	14,536	$13.51	$10.27	81
Maine	11,871	$13.39	$10.50	67
Arkansas	10,898	$12.90	$10.49	72
Oregon	10,599	$13.34	$10.32	41
Iowa	9,554	$12.64	$10.13	42
Idaho	9,529	$12.59	$9.96	48
New Hampshire	7,779	$13.63	$10.49	30
District of Columbia	5,740	$14.67	$10.59	32
Wisconsin	4,027	$13.24	$10.15	32
New Mexico	3,759	$13.52	$10.60	12
Alaska	3,655	$18.34	$10.79	23
West Virginia	3,296	$13.30	$10.56	37
South Dakota	3,054	$13.56	$10.70	3
Wyoming	2,748	$14.92	$11.81	13
Utah	2,399	$13.12	$10.30	22
Hawaii	1,655	$13.25	$9.83	17
Rhode Island	1,383	$13.85	$10.33	10
Nebraska	1,226	$13.40	$10.41	4
Minnesota	885	$13.55	$10.75	9
Montana	387	$13.48	$10.59	4
U.S. Virgin Islands	361	$13.17	$10.12	3
North Dakota	198	$13.49	$10.86	1
AE	175	$13.13	$10.05	1
Guam	157	$14.19	$10.89	1
AP	128	$13.57	$10.35	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
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.