CPT 97152: Technician-Delivered Behavioral Assessment
Commercial payers pay $68 on average nationally for this procedure.
CPT code 97152 describes a technician-administered, supervised face-to-face assessment of a patient’s destructive behavior and behavioral problems, billed in 15-minute units; service type is a technician-delivered behavioral assessment and the typical site of service is an outpatient or clinic behavioral health setting where a physician or qualified healthcare professional provides supervision.
For related coverage guidance, see recent payer policy updates: Lumbar Microdiscectomy, Artificial Cervical Intervertebral Disc, Lumbar Decompression.
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National Reimbursement Benchmarks
Commercial reimbursements for CPT 97152 cluster around the BUCA average of $67.90, with payer-specific dispersion varying notably. Blue Cross Blue Shield displays the widest interquartile spread (P75 $96.40 minus P25 $77.90 = $18.50), followed by UnitedHealth Group with a spread of $33.60 (P75 $63.60 minus P25 $29.90 = $33.70) and Cigna with $33.00 (P75 $66.00 minus P25 $32.00 = $34.00). Aetna is the tightest among listed payers, showing a narrow IQR of $3.00 (P75 $17.00 minus P25 $14.00 = $3.00).
Blue Cross Blue Shield and UnitedHealth Group exhibit the largest variability in commercial rates, indicating a broader range of negotiated payments around the BUCA mean. Cigna’s dispersion is similarly wide. Aetna’s compact spread suggests more consistency in allowed amounts for this code. These differences reflect payer-level variability in commercial contracting for CPT 97152.