CPT code 97155: Behavior treatment, protocol modification2026 Medicare rate & RVUs in Maryland
Reports face-to-face adaptive behavior treatment by a physician or qualified health care professional when the patient’s treatment protocol is modified.
CMS doesn’t publish an office rate for 97155 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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What 97155 covers
This service covers face-to-face adaptive behavior treatment for one patient when a physician or other qualified health care professional evaluates the patient’s response and modifies the treatment protocol. It may include directing a technician while treatment is being delivered. These services are used in behavioral programs, including care for people with autism, in settings such as clinics or homes.
Report the service in 15-minute units. The physician fee schedule lists 97155 as carrier priced, status C: CMS publishes no national payment, and the Medicare Administrative Contractor sets payment for each claim. Distinguish protocol-modification treatment from technician-delivered treatment, group treatment, caregiver guidance, and assessment services in the same adaptive behavior code family.
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 97155 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 97155 rate is calculated
Each of 97155’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 · 97155
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 97155
97155 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 · 97155
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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97155 isn’t priced in this setting.
97155 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 97153Adaptive behavior treatmentOne patient, technician
- 97155 is for protocol-modification treatment by a physician or qualified health care professional; 97153 is for adaptive behavior treatment delivered by a technician.
- 97156Family guidanceAdaptive behavior
- 97155 involves treatment with the patient and protocol modification. 97156 is caregiver or family guidance.
- 97158Group adaptive treatmentQHP protocol modification
- 97155 is an individual-patient service. 97158 is adaptive behavior treatment delivered in a group by a physician or qualified health care professional.
- 97151Behavior assessmentPhysician or QHP
- 97155 reports treatment with protocol modification; 97151 is for adaptive behavior assessment by a physician or qualified health care professional.
97155 billing questions
When should 97155 be used instead of 97153?
Use 97155 for face-to-face adaptive behavior treatment with protocol modification by a physician or qualified health care professional. Code 97153 describes adaptive behavior treatment delivered by a technician.
How many minutes does one unit represent?
One unit represents 15 minutes of the service. Keep documentation of the face-to-face treatment and the protocol modification supporting the reported time.
Can 97155 include direction of a technician?
Yes. The service may include the physician or qualified health care professional directing a technician while treatment is delivered.
How does 97155 differ from caregiver guidance?
97155 is treatment with the patient and protocol modification. Code 97156 describes adaptive behavior treatment guidance for a caregiver or family member.
How does Medicare price 97155?
Its physician fee schedule status is carrier priced (status C). CMS publishes no national payment; the Medicare Administrative Contractor sets payment for each 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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