97155 Adapt behavior tx phys/qhp

What 97155 is

CMS fee schedule short descriptor: Adapt behavior tx phys/qhp.

Full CPT long descriptions are licensed by the American Medical Association and are not published on this site; the short descriptor above is the one CMS prints in its own fee schedule file. See About CPT.

Medicare payment for 97155 (CY2026)

This code has no Physician Fee Schedule rate: Carrier-priced - the Medicare contractor sets the price. It may be paid under a different fee schedule (clinical laboratory, DMEPOS, anesthesia) or not paid at all - check the relevant CMS schedule.

Medically Unlikely Edit (MUE)

Medicare caps 97155 at 24 units per date of service for practitioner claims (MAI 3 - date of service edit (clinical): units above the MUE may pay with documentation on appeal), rationale: Clinical: Society Comment. Units above the cap are denied unless the edit's adjudication rules allow an appeal with documentation.

Billed with 97155? These codes are bundled into it

97155 is a Column 1 code in 14 active NCCI PTP edits. When one of these Column 2 codes is reported on the same date of service, it is denied as bundled - unless the edit's modifier indicator is 1 and documentation supports a distinct service with an NCCI-associated modifier.

97155 is bundled into these codes

97155 appears as a Column 2 code in 225 active edits. Reported with one of these Column 1 codes on the same date of service, 97155 is the code that denies.

Data: CMS CY2026 Physician Fee Schedule RVU file (October release, RVU26D) and Medicare NCCI PTP practitioner edits v32.3 (2026 Q4). Verify against the official files before billing or contracting decisions.