CPT code 97130: Cognitive intervention, each additional 15 minutes2026 Medicare rate & RVUs in Missouri
Reports additional one-on-one cognitive function treatment addressing skills such as attention, memory, reasoning, and executive function after the initial timed service.
Medicare pays $20.35–$20.80 for 97130 in the office in Missouri, from Rest of Missouri to Metropolitan St. Louis, MO. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What 97130 covers
A therapist or other qualified health care professional uses skilled, direct one-on-one treatment to address cognitive functions that affect daily activities. Targets may include attention, memory, reasoning, executive function, problem solving, or pragmatic functioning. Treatment can also teach compensatory approaches, such as using a schedule or organizing and sequencing a task. It is commonly provided in outpatient rehabilitation for people with cognitive changes following stroke, brain injury, or neurologic disease.
Report 97130 only as an add-on to 97129, the primary code for the initial timed portion of this intervention. Each unit represents an additional 15 minutes of treatment; documentation should identify the cognitive goals, skilled interventions, direct patient contact, and time supporting the added service. CMS treats this as an add-on paid within the primary procedure’s global period. Do not use the same treatment minutes to support another timed service.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 97130 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$20.35 to $20.80
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | $20.74 | $18.23 |
| Metropolitan St. Louis, MO | $20.80 | $18.26 |
| Rest of Missouri | $20.35 | $18.05 |
How the 97130 rate is calculated
Each of 97130’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 97130
RVUs × geographic indexes × conversion factor
Work0.48
0.48 RVUs× 1.000 GPCI
Practice expense0.15
0.15 RVUs× 1.000 GPCI
Malpractice0.00
0.00 RVUs× 1.000 GPCI
Adjusted RVUs
0.6300
Conversion factor
$33.4009
Medicare rate
$21.04
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 97130
The CMS indicators that decide how 97130 is paid alongside other services.
CMS payment indicators · 97130
Cognitive intervention, each additional 15 minutes
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
97130 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 97129Cognitive therapyInitial 15 minutes
- 97129 reports the initial timed portion of cognitive function intervention. Use 97130 only for additional treatment time and only with 97129.
- 97112Neuromuscular reeducationBalance, coordination, proprioception, timed
- 97130 focuses on cognitive skills and compensatory strategies; 97112 focuses on neuromuscular reeducation, such as movement or balance control.
- 97535Self-care trainingADL and home management, per 15 minutes
- Use 97535 when the skilled service is self-care or home management training. Use 97130 when the treatment focus is cognitive function intervention.
97130 billing questions
Can 97130 be reported by itself?
No. It is an add-on code and must be reported with 97129 for the initial portion of the cognitive function intervention.
What treatment supports reporting 97130?
Skilled, direct one-on-one work on cognitive functions such as attention, memory, reasoning, executive function, or problem solving, including compensatory strategies tied to activity performance.
How much time does one unit represent?
One unit represents an additional 15 minutes beyond the initial service reported with 97129. The record should support the treatment time and the additional skilled intervention.
How does 97130 differ from 97112?
Use 97130 for skilled intervention focused on cognitive function and strategies for managing activities. Use 97112 when the treatment addresses neuromuscular reeducation, such as movement, balance, or coordination.
Can the same minutes support 97130 and another timed therapy code?
No. The minutes reported for 97130 should represent additional cognitive treatment time, not time already counted toward another timed service.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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