How much does Medicare pay for CPT 97550?

Medicare allowed an average of $51.87 per service and paid $40.97 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $110.67, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Does 97550 pay differently in an office than a hospital?

Yes. The allowed amount averaged $52.13 in an office setting and $45.37 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 97550 most?

Internal Medicine, with 2,321 services from 17 clinicians. Next are Physical Therapist in Private Practice, Nurse Practitioner, Occupational Therapist in Private Practice.

CPT 97550

Caregiver training in strategies and techniques to facilitate the patient's functional performance in the home or community, initial 30 minutes

$51.87Medicare-allowed amount per service, averaged across 8,353 services

Providers submitted

$110.67

Asking price, not received

Medicare allowed

$51.87

The fee schedule figure

Medicare paid

$40.97

Balance is patient coinsurance

Providers submitted an average of $110.67 for this code and Medicare allowed $51.87 — 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 $40.97 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $52.13
Hospital / facility: $45.37

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. 8,030 services were billed in an office setting and 323 in a facility.

Services: 8,353
Beneficiaries: 3,392
Providers billing it: 85
Total allowed: $433,270

What Medicare pays for CPT 97550

Across 8,353 services billed by 85 providers to 3,392 beneficiaries, Medicare allowed an average of $51.87 per service. That is 2.5 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 97550

Specialty	Services	Beneficiaries	Avg allowed	Providers
Internal Medicine	2,321	1,089	$52.68	17
Physical Therapist in Private Practice	1,110	305	$51.49	16
Nurse Practitioner	1,019	533	$43.93	7
Occupational Therapist in Private Practice	1,017	246	$51.45	12
Speech Language Pathologist	947	162	$51.73	6
Family Practice	812	427	$53.84	10
Cardiology	236	77	$62.30	2
General Practice	220	114	$56.10	2
Plastic and Reconstructive Surgery	184	120	$56.46	2
Geriatric Medicine	120	89	$55.74	2
Neurology	106	75	$52.54	1
Physical Medicine and Rehabilitation	74	30	$56.36	1
Emergency Medicine	61	47	$54.11	3
Nephrology	48	21	$56.71	1
General Surgery	42	25	$51.48	1

97550 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	3,059	$55.06	$40.99	21
Florida	1,707	$49.02	$38.52	17
Texas	835	$49.69	$39.93	6
New York	767	$53.70	$38.04	8
Illinois	419	$50.62	$38.52	4
Tennessee	208	$45.89	$37.48	3
New Jersey	202	$50.28	$38.81	4
Nevada	191	$40.97	$35.27	1
Ohio	159	$52.22	$40.92	4
Wisconsin	132	$50.49	$41.46	2
Alabama	96	$49.26	$41.50	1
Delaware	91	$51.08	$40.40	1
Colorado	72	$52.18	$40.92	2
Connecticut	55	$53.80	$41.69	1
Minnesota	53	$51.26	$41.37	1
Georgia	49	$51.99	$41.37	1
Maryland	47	$50.04	$36.17	2
Michigan	43	$53.72	$41.49	1
North Carolina	42	$47.06	$38.09	1
Arizona	42	$51.48	$41.50	1
District of Columbia	39	$57.63	$41.50	1
South Carolina	25	$50.21	$41.50	1
Oregon	20	$53.95	$41.49	1

Related codes

97530Therapy procedure$31.54
97535Training for self-care or home management$25.35
97597Removal of tissue from wound$74.53
97533Therapy procedure$52.00
97598Removal of tissue from wound$33.10
97542Evaluation for wheelchair$23.83
97537Training for community or work reintegration$24.91

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.