localis
Calculator

Describe a service in plain words, or type a CPT/HCPCS code.

CPT 97153

No national payment amount

Carrier-priced: no national payment amount.

Did Medicare pay separately for CPT 97153 in Q3 2020?

Not at a published national rate. CPT 97153 carries status C (carrier-priced) in the Q3 2020 release. Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation. Treat the blank amount as unpriced, not as $0.

Source: Physician relative value file (Q3 2020) · effective July 2020 · materially updated Aug 4, 2026 · compact facts

Common questions

Why is there no payment amount for 97153?

Its status indicator is C (carrier-priced). Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation. The blank is deliberate: the amount is either unknown or paid under another provision, so reading it as $0 would be wrong.

Why would a Medicare claim for 97153 be denied or paid less?

Each item below comes from a CMS indicator on this page — not general billing advice.

Payer-specific coverage and documentation rules live outside these files, so a claim that clears every check here can still be denied on other grounds.

When does this rate change?

CMS publishes a fee schedule release every quarter (January, April, July, October), and each is versioned here. See what changed each release, or get an email when a new release moves rates.

Sources: CMS Medicare Physician Fee Schedule Relative Value Files.

Saw this code on your bill?

What is a 97153 visit in patient-friendly terms?

We haven't written the plain-language description for CPT 97153 yet — ask your provider's billing office what service it covers in the meantime.

Computation & policy

How this amount is computed

amount = (work RVU × work GPCI + PE RVU × PE GPCI + MP RVU × MP GPCI) × conversion factor. National amounts use GPCI = 1.000. To price an RVU figure of your own, use the RVU-to-dollars converter.

Release Q3 2020
Component RVU
Work RVU blank
Practice expense RVU (non-facility) blank
Practice expense RVU (facility) blank
Malpractice RVU blank

Every rate combines three parts: work (the clinician’s time, skill and effort), practice expense (office overhead — higher when the service is done in a doctor’s own office), and malpractice (the share of liability-insurance cost). A blank means CMS publishes no national number for that part. Read it as unknown, and never as zero.

Billing policy

What 97153's billing-policy indicators mean. These show for every code, priced or not: a restriction like "bilateral not allowed" still matters on a carrier-priced code.

Policy Value What it means
Bilateral surgery 0 No bilateral adjustment. The 150% bilateral payment adjustment does not apply to this procedure.
Assistant at surgery 0 Restricted without documentation. Payment for an assistant at surgery is restricted for this procedure unless supporting documentation establishes medical necessity.
Co-surgeons 0 Not permitted. Medicare does not recognize co-surgeons (modifier 62) for this procedure.
Team surgery 0 Not permitted. Medicare does not recognize a surgical team (modifier 66) for this procedure.
Multiple procedures 0 No reduction. No payment reduction applies when this procedure is billed with other procedures on the same date — each is treated as unrelated.
Professional/technical split 0 No PC/TC split. This is a physician service code; the professional/technical split does not apply, and the code is billed as a single service.
History & related

Rate history by release

National non-facility amount for 97153 across quarterly releases.

Release Status Non-facility Facility
Q3 2026 Jun 30, 2026 – present C — —
Q2 2026 Mar 10, 2026 – Jun 29, 2026 C — —
Q1 2026 Dec 29, 2025 – Mar 9, 2026 C — —

Did this answer your question about CPT 97153?

We're building this out in the open. Tell us what you were actually trying to work out and we'll either answer you directly or build the page that does.

Did this page answer your question?

Source & method

Show sources

This is computed from CMS's Medicare Physician Fee Schedule Q3 2020 release (schedule pfs, effective July 2020). National amounts apply a GPCI of 1.000 and leave sequestration off. The status indicator decides payability, never the RVU values, so a blank RVU stays blank. Releases are immutable: a rate retrieved for a past quarter always reflects that release. Commercial and cash-pay figures anywhere on this page are arithmetic on the Medicare amount, using commonly cited reimbursement ranges. They're illustrative, and no nationwide claims database stands behind them. Our methodology covers all of this in depth — sourcing, parsing, versioning, and how claims are cross-checked before they ship.

Physician relative value file (Q3 2020) · rvu20c-updated-06192020.zip (PPRRVU20_V0618.csv row 17,032)

Conversion factor $36.0896 read from the same file, row 11, column 25.

Use the (i) buttons next to each amount above for the exact row, columns, and math.

Cite this rate

This link keeps pointing at the Q3 2020 figures, even after a newer release lands.

CPT 97153 Medicare Physician Fee Schedule rate (Q3 2020). Localis. https://localishealth.com/cpt/97153/2020/C