CPT code 97158: Group adaptive treatment, QHP protocol modification2026 Medicare rate & RVUs in New Mexico

CMS doesn’t publish a rate for 97158 in New Mexico.

Check a contract rate as a % of Medicare · 97158 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 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.

How New Mexico compares for 97158

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97158 rates by state

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

See 97158 in every payment locality

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.

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.

Codes related to 97158

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

How 97158 has changed in New Mexico

Price 97158 for an earlier date of service

Where the New Mexico rate applies

New Mexico is a Medicare payment area, not a city. Our Census mapping connects it to 528 cities and communities in New Mexico. Some span more than one payment area; confirm with the service ZIP.

• Abeytas
• Abiquiu
• Acomita Lake
• Adelino
• Agua Fria
• Alamillo
• Alamo
• Alamogordo

Browse all communities in New Mexico

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