CPT 97151: Behavioral Assessment and Care Plan Development
Commercial payers pay $75 on average nationally for this procedure.
CPT code 97151 describes a physician or qualified healthcare professional performing an in‑person comprehensive behavioral assessment that includes administering and scoring multiple tests, interpreting results, developing a plan of care, preparing a report, and discussing findings and recommendations with the parent, guardian, or caregiver; service type is behavioral assessment and care planning, and the typical site of service is office- or clinic-based, face-to-face evaluation with additional non–face-to-face data analysis, reported in 15‑minute time increments.
For related coverage guidance, see recent payer policy updates: Lumbar Microdiscectomy, Artificial Cervical Intervertebral Disc, Lumbar Decompression.
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National Reimbursement Benchmarks
National commercial reimbursement for CPT 97151 centers roughly on BUCA’s average commercial rate of $74.80, which serves as a practical mid-market benchmark. Blue Cross Blue Shield shows the highest mean and greatest dispersion with a P75–P25 range of $23.90 ($104.20 minus $82.90), indicating wide variability across contracts. Cigna’s distribution is moderately wide with a range of $30.80 ($69.00 minus $38.20). UnitedHealth Group and Aetna are comparatively tighter: UnitedHealth Group has a P75–P25 range of $47.90 ($76.80 minus $29.90), and Aetna’s interquartile spread is $5.00 ($24.00 minus $19.00), the narrowest among these payers.
Examining central tendency, Cigna and UnitedHealth Group have mean rates ($56.50 and $58.30) near BUCA’s average, while Blue Cross Blue Shield’s mean ($96.40) sits well above it, reflecting higher-paying contracts at the upper tail (max $221.40). Aetna’s mean ($22.80) is substantially lower than BUCA. These contrasts highlight payer-specific contracting behaviors: some payers concentrate around a tighter band while others exhibit long upper tails that elevate the mean.