CPT code 97158: Group adaptive treatment, QHP protocol modification2026 Medicare rate & RVUs in Guam
Reports a physician’s or qualified health care professional’s face-to-face group adaptive behavior treatment when the treatment protocol is modified.
CMS doesn’t publish an office rate for 97158 in Guam.
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 97158 covers
This service covers face-to-face adaptive behavior treatment delivered by a physician or other qualified health care professional to multiple patients as a group, with modification of the treatment protocol. It is used in behavioral treatment programs when the clinician provides treatment and adjusts the approach in response to patients’ needs and progress. The group format distinguishes it from individual adaptive behavior treatment and from caregiver guidance.
For Medicare Physician Fee Schedule purposes, status C means CMS publishes no national payment, and the Medicare Administrative Contractor sets payment for each claim. The code is reported in 15-minute units. Documentation should support the group treatment provided, the clinician’s protocol modification, the patients served, and the time reported for each patient. Technician-led group adaptive behavior treatment is described by 97154; 97158 identifies the physician or qualified health care professional 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.
97158 in Hawaii, Guam, HI
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam, HI | Unavailable | Unavailable |
How the 97158 rate is calculated
Each of 97158’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 · 97158
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 97158
97158 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 · 97158
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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97158 isn’t priced in this setting.
97158 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 97154Group behavior treatmentTechnician, per 15 minutes
- Both involve group adaptive behavior treatment, but 97158 is the qualified professional’s service with protocol modification; 97154 is technician-delivered.
- 97155Behavior treatmentProtocol modification
- 97155 describes individual adaptive behavior treatment with protocol modification. Choose 97158 when the qualified professional provides that treatment to multiple patients as a group.
- 97150Group therapyTwo or more patients, per session
- 97150 describes group therapeutic procedures generally. 97158 is specific to group adaptive behavior treatment with protocol modification by a physician or qualified health care professional.
- 97156Family guidanceAdaptive behavior
- 97156 describes adaptive behavior guidance for a caregiver. 97158 describes adaptive behavior treatment delivered to multiple patients as a group.
97158 billing questions
How is 97158 different from 97154?
Both describe group adaptive behavior treatment. 97158 is for treatment with protocol modification by a physician or other qualified health care professional; 97154 is technician-delivered.
When should 97158 be used instead of 97155?
Use 97158 for the qualified professional’s protocol-modification service delivered to multiple patients as a group. 97155 describes individual adaptive behavior treatment with protocol modification.
How many units does 97158 represent?
Each unit represents 15 minutes. The record should support the time and group treatment provided for each patient.
What should the documentation show?
Document the group adaptive behavior treatment, the qualified professional’s protocol modification, the patients involved, and the time supporting the units reported.
What does Medicare status C mean for 97158?
CMS publishes no national payment for this code. 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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