CPT code 97151: Behavior assessment, physician or QHP2026 Medicare rate & RVUs in Maryland
A physician or qualified health professional assesses behavior, interprets findings, and prepares recommendations when evaluating a patient for adaptive behavior services.
CMS doesn’t publish an office rate for 97151 in Maryland.
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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On this page 9 sections
What 97151 covers
This code covers a behavioral assessment performed by a physician or other qualified health professional. The work can include meeting with the patient or caregiver, administering assessment tools, reviewing prior information, interpreting results, and preparing findings and recommendations. It is used in behavioral care to assess adaptive behavior needs; it describes assessment work, not ongoing behavioral treatment.
Each unit represents 15 minutes of the professional’s assessment time, including face-to-face assessment and related analysis and reporting activities. For Medicare physician fee schedule purposes, status C means CMS publishes no national payment amount; the Medicare Administrative Contractor prices each claim. The code is in the CPT Category I code set.
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 97151 pays more and less in Maryland
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Baltimore area, MD | Unavailable | Unavailable |
| Rest of Maryland | Unavailable | Unavailable |
| Washington, DC area | Unavailable | Unavailable |
How the 97151 rate is calculated
Each of 97151’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 · 97151
RVUs × geographic indexes × conversion factor
Work0.00
0.00 RVUs× 1.000 GPCI
Practice expense0.00
0.00 RVUs× 1.000 GPCI
Malpractice0.00
0.00 RVUs× 1.000 GPCI
Adjusted RVUs
0.0000
Conversion factor
$33.4009
Medicare rate
$0.00
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 97151
97151 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.
Place of service · 97151
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
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97151 isn’t priced in this setting.
97151 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 97152Behavior assessmentTechnician support
- Use 97151 for the physician’s or qualified health professional’s assessment. 97152 describes supporting assessment performed by a technician under professional direction.
- 97153Adaptive behavior treatmentOne patient, technician
- 97153 describes adaptive behavior treatment delivered by a technician; 97151 is assessment work by a physician or qualified health professional.
- 97155Behavior treatmentProtocol modification
- 97155 describes treatment with protocol modification by a physician or qualified health professional. Choose 97151 for assessment, not treatment modification.
- 97156Family guidanceAdaptive behavior
- 97156 is caregiver guidance about adaptive behavior treatment. 97151 is the professional’s assessment of behavior and related recommendations.
97151 billing questions
Who reports 97151?
A physician or other qualified health professional reports the assessment. Technician-delivered supporting assessment is described by 97152.
What work is included in the assessment?
The service may include patient or caregiver interviews, assessment administration, review and interpretation of information, and preparation of findings and recommendations.
How many minutes does one unit represent?
One unit represents 15 minutes of the physician’s or qualified health professional’s assessment time. The code includes related assessment analysis and reporting work.
How is 97151 different from 97153?
97151 is assessment by a physician or qualified health professional. 97153 describes adaptive behavior treatment delivered by a technician.
How does Medicare price 97151?
CMS assigns status C, meaning there is no national physician fee schedule payment amount. The Medicare Administrative Contractor prices the claim.
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
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