CPT code 97151: Behavior assessment, physician or QHP2026 Medicare rate & RVUs in Virginia

CMS doesn’t publish a rate for 97151 in Virginia.

Check a contract rate as a % of Medicare · 97151 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

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.

How Virginia compares for 97151

Every other payment area

97151 rates by state

Office rate range in each state. Select a state to see its payment localities.

See 97151 in every payment locality

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.

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.

Codes related to 97151

Related codes aren’t interchangeable: bill the code that matches the service performed.

How 97151 has changed in Virginia

Price 97151 for an earlier date of service

Where the Virginia rate applies

Virginia is a Medicare payment area, not a city. Our Census mapping connects it to 628 cities and communities in Virginia. Some span more than one payment area; confirm with the service ZIP.

• Abbs Valley
• Abingdon
• Accomac
• Adwolf
• Afton
• Alberta
• Aldie
• Allison Gap

Browse all communities in Virginia

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

Open CMS sourceHow we calculate rates