CPT 97811 Medicare payment status

Payment rules for 97811 Copy link

Global period: what 97811's fee already covers Copy link

This code is always billed alongside another service and carries no follow-up period of its own. The primary procedure's global period governs; this indicator does not determine whether either line is payable.

Check a pair of codes 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 for the pair.

See every current NCCI pair for 97811 →

Why a 97811 line may not pay separately Copy link

CMS publishes no separately payable amount for 97811 in this release, so reconciling the line means establishing which status governed the date of service rather than chasing a fee-schedule difference.

Sources: CMS Medicare Physician Fee Schedule Relative Value Files; CMS Medicare Physician Fee Schedule Relative Value Files (status indicator field); CMS Medicare Claims Processing Manual (Pub. 100-04).

Rate history by release Copy link

National Office (non-facility) amount for 97811 across quarterly releases. -1.7% decrease since Q2 2020 · peak $30.11 in Q1 2022

How often 97811 is billed Copy link

Across Original Medicare in CY2024, 97811 ranked #2,049 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars. It repeats: a patient billed for it in 2024 was billed 8.3 times on average that year.

2024 Medicare fee-for-service national totals. They exclude Medicare Advantage, Medicaid and commercial volume, so real-world use runs higher. This is a calendar-year snapshot from the CMS Physician & Other Practitioners dataset, on a different cycle from the Q1 2013 fee schedule above.

Related codes Copy link

Codes near 97811 in the medicine services group, with their national Q1 2013 amounts at GPCI 1.000. A dash means the release publishes no payable PFS amount in that setting.

Localis groups these codes for payment research. The grouping isn't the AMA's code families.