CPT 97157
Contractor-priced
97157 · PFS Q3 2026
Contractor-published range
$9.82–$10.97
Participating · Office (non-facility) · Whole service
MAC-published fee schedules available in Localis: 20 of 144 payment localities. Missing data does not establish a $0 allowance.
No national PFS rate in Q3 2026
Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.
Check for a published amount in your locality.
CPT 97157 carries status C (carrier-priced) in the Q3 2026 release, so there is no single national rate—Medicare contractors publish their own amounts. Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation. Contractor-published amounts on file range $9.82–$10.97 across 20 localities; enter a ZIP for the exact local amount.
Amount evidence: MAC-published fee schedules and effective dates. The PFS row establishes contractor pricing.
Inspect PFS status evidence
- Code
- 97157
- Release
- Q3 2026, revision 1
- Result
- Contractor-priced
Citations
-
Establishes the PFS status (C) and the resulting pathway for this code: contractor-priced.
Physician relative value file (PPRRVU)Q3 2026 · revision 1
Latest revision of this release
Release period: July 1 – September 30, 2026
This PFS record alone does not establish a $0 allowance or a coverage determination. Any amount from another schedule needs its own evidence.
Record details
PPRRVU2026_Jul_nonQPP.csv in rvu26c-updated-06-30-2026.zip (row 12,814)- hcpcs (col 1)
- 97157
- modifier (col 2)
- blank
- status_code (col 4)
- C
SHA-256: b7d197e73211ef6854c213c267d5fa9dec8df995db8e1ee7d44c0556ad7cee21
Why is there no national PFS amount for 97157?
Its status indicator is C (carrier-priced). Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation. Carrier-priced: no national payment amount.
Payment considerations Copy link
Review the applicable inputs and payment rules. Each link opens the supporting detail on this page.
Other payment indicators (8)
Facility/non-facility: Not determined, Professional/technical component: Does not apply, Bilateral adjustment: Does not apply, Multiple-procedure reduction: Does not apply, Assistant/co-surgeon treatment: Does not apply, Global surgery: Does not apply, MUE behavior: Not determined, Other fee-schedule routing: Does not apply.
Find the local Medicare amount for 97157 Copy link
Medicare sets this price locally
97157 has no single national Physician Fee Schedule amount. Use the ZIP, modifier, setting, and participation fields above to match it to a Medicare locality and the contractor amount we have on file.
Your practical estimate will appear here
We hold files from First_coast and Novitas across JH and JN, most recently effective Jan 1, 2026. A missing locality means our contractor coverage is incomplete—not that Medicare pays $0.
This is the published amount for this code—not necessarily the entire visit or procedure. A hospital may bill a separate facility charge, and other services, drugs, or supplies can add to the total.
View all 40 published fee rows
| Jurisdiction / locality | Modifier | Note | Par | Non-par | Limiting charge | Effective | Source |
|---|---|---|---|---|---|---|---|
| JH · Arkansas, Area 13 CMS 07102-13 | — | — | $9.82 | $9.33 | $10.73 | Jan 1, 2026 | Contractor file |
| JH · Arkansas, Area 13 CMS 07102-13 | — | # | $8.95 | $8.50 | $9.78 | Jan 1, 2026 | Contractor file |
| JH · Colorado, Area 01 CMS 04112-01 | — | — | $10.54 | $10.01 | $11.51 | Jan 1, 2026 | Contractor file |
| JH · Colorado, Area 01 CMS 04112-01 | — | # | $9.47 | $9.00 | $10.35 | Jan 1, 2026 | Contractor file |
| JH · Louisiana, Area 01 CMS 07202-01 | — | — | $10.24 | $9.73 | $11.19 | Jan 1, 2026 | Contractor file |
| JH · Louisiana, Area 01 CMS 07202-01 | — | # | $9.30 | $8.84 | $10.17 | Jan 1, 2026 | Contractor file |
| JH · Louisiana, Area 99 CMS 07202-99 | — | — | $10.03 | $9.53 | $10.96 | Jan 1, 2026 | Contractor file |
| JH · Louisiana, Area 99 CMS 07202-99 | — | # | $9.15 | $8.69 | $9.99 | Jan 1, 2026 | Contractor file |
| JH · Mississippi, Area 00 CMS 07302-00 | — | — | $9.90 | $9.41 | $10.82 | Jan 1, 2026 | Contractor file |
| JH · Mississippi, Area 00 CMS 07302-00 | — | # | $9.03 | $8.58 | $9.87 | Jan 1, 2026 | Contractor file |
| JH · New Mexico, Area 05 CMS 04212-05 | — | — | $10.20 | $9.69 | $11.14 | Jan 1, 2026 | Contractor file |
| JH · New Mexico, Area 05 CMS 04212-05 | — | # | $9.28 | $8.82 | $10.14 | Jan 1, 2026 | Contractor file |
| JH · Oklahoma, Area 00 CMS 04312-00 | — | — | $9.99 | $9.49 | $10.91 | Jan 1, 2026 | Contractor file |
| JH · Oklahoma, Area 00 CMS 04312-00 | — | # | $9.10 | $8.65 | $9.95 | Jan 1, 2026 | Contractor file |
| JH · Texas, Area 09 CMS 04412-09 | — | — | $10.32 | $9.80 | $11.27 | Jan 1, 2026 | Contractor file |
| JH · Texas, Area 09 CMS 04412-09 | — | # | $9.32 | $8.85 | $10.18 | Jan 1, 2026 | Contractor file |
| JH · Texas, Area 11 CMS 04412-11 | — | — | $10.36 | $9.84 | $11.32 | Jan 1, 2026 | Contractor file |
| JH · Texas, Area 11 CMS 04412-11 | — | # | $9.36 | $8.89 | $10.22 | Jan 1, 2026 | Contractor file |
| JH · Texas, Area 15 CMS 04412-15 | — | — | $10.34 | $9.82 | $11.29 | Jan 1, 2026 | Contractor file |
| JH · Texas, Area 15 CMS 04412-15 | — | # | $9.34 | $8.87 | $10.20 | Jan 1, 2026 | Contractor file |
| JH · Texas, Area 18 CMS 04412-18 | — | — | $10.52 | $9.99 | $11.49 | Jan 1, 2026 | Contractor file |
| JH · Texas, Area 18 CMS 04412-18 | — | # | $9.52 | $9.04 | $10.40 | Jan 1, 2026 | Contractor file |
| JH · Texas, Area 20 CMS 04412-20 | — | — | $10.09 | $9.59 | $11.03 | Jan 1, 2026 | Contractor file |
| JH · Texas, Area 20 CMS 04412-20 | — | # | $9.18 | $8.72 | $10.03 | Jan 1, 2026 | Contractor file |
| JH · Texas, Area 28 CMS 04412-28 | — | — | $10.34 | $9.82 | $11.29 | Jan 1, 2026 | Contractor file |
| JH · Texas, Area 28 CMS 04412-28 | — | # | $9.35 | $8.88 | $10.21 | Jan 1, 2026 | Contractor file |
| JH · Texas, Area 31 CMS 04412-31 | — | — | $10.49 | $9.97 | $11.47 | Jan 1, 2026 | Contractor file |
| JH · Texas, Area 31 CMS 04412-31 | — | # | $9.43 | $8.96 | $10.30 | Jan 1, 2026 | Contractor file |
| JH · Texas, Area 99 CMS 04412-99 | — | — | $10.19 | $9.68 | $11.13 | Jan 1, 2026 | Contractor file |
| JH · Texas, Area 99 CMS 04412-99 | — | # | $9.23 | $8.77 | $10.09 | Jan 1, 2026 | Contractor file |
| JN · Florida, Area 03 CMS 09102-03 | — | — | $10.66 | $10.13 | $11.65 | Jan 1, 2026 | Contractor file |
| JN · Florida, Area 03 CMS 09102-03 | — | # | $9.64 | $9.16 | $10.53 | Jan 1, 2026 | Contractor file |
| JN · Florida, Area 04 CMS 09102-04 | — | — | $10.97 | $10.42 | $11.98 | Jan 1, 2026 | Contractor file |
| JN · Florida, Area 04 CMS 09102-04 | — | # | $9.93 | $9.43 | $10.84 | Jan 1, 2026 | Contractor file |
| JN · Florida, Area 99 CMS 09102-99 | — | — | $10.40 | $9.88 | $11.36 | Jan 1, 2026 | Contractor file |
| JN · Florida, Area 99 CMS 09102-99 | — | # | $9.45 | $8.98 | $10.33 | Jan 1, 2026 | Contractor file |
| JN · Puerto Rico, Area 20 CMS 09202-20 | — | — | $10.38 | $9.86 | $11.34 | Jan 1, 2026 | Contractor file |
| JN · Puerto Rico, Area 20 CMS 09202-20 | — | # | $9.37 | $8.90 | $10.24 | Jan 1, 2026 | Contractor file |
| JN · U.S. Virgin Islands, Area 50 CMS 09202-50 | — | — | $10.38 | $9.86 | $11.34 | Jan 1, 2026 | Contractor file |
| JN · U.S. Virgin Islands, Area 50 CMS 09202-50 | — | # | $9.37 | $8.90 | $10.24 | Jan 1, 2026 | Contractor file |
The authenticated MAC fees API returns the same source rows. ZIP5s that span localities are flagged and use only the crosswalk's dominant locality until ZIP+4 overrides are available.
Reconciling a contractor-priced payment for 97157 Copy link
There is no national allowed amount for 97157, so every reconciliation of this line runs against the MAC fee schedule that was in force for the date of service rather than against a national baseline.
What to reconcile
- Compare the paid amount against the MAC fee schedule in force for the date of service; there is no national allowed amount here to reconcile against.
- Check for documentation on file before appealing an assistant-at-surgery denial: payment on the -80 or -AS line is restricted for this procedure unless medical necessity is established.
- Reprice the line against the release, locality, setting, modifier and participation status that applied to the date of service before treating any difference as an underpayment.
Nearby payment lines
National Q3 2026 amounts at GPCI 1.000. A blank means this schedule does not publish a payable PFS amount.
Sources: CMS Medicare Physician Fee Schedule Relative Value Files; CMS Medicare Physician Fee Schedule Relative Value Files (status indicator field); 42 USC 1395w-4(i)(2) (SSA §1848(i)(2))—Assistants-at-surgery.
Global period: what 97157's fee already covers Copy link
The global surgery concept does not apply to this code.
Billing policy Copy link
What 97157'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. |
Can you bill it with another code? Copy link
Enter a second CPT or HCPCS code billed on the same date of service. We'll check the current NCCI procedure-to-procedure edit between it and 97157.
Billing together (NCCI edits) Copy link
NCCI Q3 2026Based on CMS's National Correct Coding Initiative (NCCI). A few examples appear here; use the complete edit page to check a specific pair.
Not separately payable with 97157 on the same date of service—no modifier bypasses the edit (modifier indicator 0)
Showing 3 of 64.
Separately payable with 97157 only when an NCCI-associated modifier is appropriate and documented (modifier indicator 1)
Showing 3 of 175.
Modifier 59 and the X modifiers are not a universal bypass—CMS expects the most specific applicable modifier, and which one that is depends on the pair and the documented circumstances.
Common payment questions Copy link
Why would a Medicare claim for 97157 be denied or paid less?
These come from CMS indicators on this page, not general billing advice.
- Its status indicator is C (carrier-priced)—Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation. See status indicators
- 64 codes form NCCI pairs with 97157 carrying modifier indicator 0—no NCCI-associated modifier bypasses the edit, so billed together on the same date of service, a line of the pair denies. See billing together
- 175 codes pair with 97157 under modifier indicator 1—separately payable only when an NCCI-associated modifier (59, or a more specific XE, XS, XP, or XU) is clinically appropriate and the documentation supports a distinct service; without one, a line of the pair denies. See billing together
- Bilateral surgery: no bilateral adjustment. See billing policy
- Assistant at surgery: restricted without documentation. See billing policy
- Co-surgeons: not permitted. See billing policy
- Team surgery: not permitted. See billing policy
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.
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Source & method
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Contractor amounts come from the MAC-published schedules and effective dates identified above. The PFS file establishes contractor pricing. Releases are immutable: historical evidence remains tied to the specified release. Our methodology covers the depth: sourcing, parsing, versioning, and how we cross-check claims before they ship.
Use the (i) buttons next to each amount above for the exact row, columns, and math.
Cite this rate
This citation identifies the source release, so its evidence remains reproducible after a newer release lands.
CPT 97157 National PFS baseline: No national PFS rate (Q3 2026; participating; whole service; GPCI 1.000; sequestration excluded). Localis. https://localishealth.com/cpt/97157/2026/C