CPT 97551
Global ZZZ ActiveCaregiver traing ea addl 15
CPT 97551 Billing & Documentation Guide
CPT code 97551 (Caregiver traing ea addl 15) is classified under Physical Medicine with a global period indicator of ZZZ. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.54, a non-facility practice expense RVU of 0.24, and a malpractice RVU of 0, a total non-facility RVU of 0.78 and facility RVU of 0.63. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $26.77, though rates vary from $24.92 to $35.59 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 97551, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify current NCCI edits before bundling with related codes.
Payment Status & Global Period
Active code (paid under MPFS)
Add-on code (global concept does not apply)
MUE Limit (Medically Unlikely Edits)
Submitting more than 2 units of 97551 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 97551
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.54 | 0.54 |
| Practice Expense RVU | 0.24 | 0.09 |
| Malpractice RVU | 0 | 0 |
| Total RVU | 0.78 | 0.63 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 97551
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $28.17 | $22.24 | $27.13 - $31.58 | 29 |
| Florida | $26.08 | $21.05 | $25.7 - $26.38 | 3 |
| Georgia | $25.72 | $20.93 | $25.19 - $26.24 | 2 |
| Illinois | $25.85 | $21 | $25.36 - $26.4 | 4 |
| Michigan | $25.56 | $20.86 | $25.36 - $25.77 | 2 |
| North Carolina | $25.52 | $20.84 | $25.52 - $25.52 | 1 |
| New York | $27.84 | $22.24 | $25.65 - $28.72 | 5 |
| Ohio | $25.36 | $20.78 | $25.36 - $25.36 | 1 |
| Pennsylvania | $26.06 | $21.15 | $25.4 - $26.71 | 2 |
| Texas | $26.03 | $21.1 | $25.33 - $26.55 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
Frequently Asked Questions, CPT 97551
What does CPT code 97551 mean? +
CPT code 97551 represents: Caregiver traing ea addl 15. It's in the Physical Medicine category with a global period of ZZZ.
What is the Medicare reimbursement for CPT 97551? +
The 2026 Medicare national average non-facility payment for CPT 97551 is $26.77. Rates range from $24.92 to $35.59 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 97551? +
Medicine section spans a wide range: therapy services use GP/GO/GN (PT/OT/SLP plans of care) and KX (above cap with documentation). Drug administration uses JW (waste) and JZ (no waste). Professional/technical split applies to some diagnostic codes.
What bundling edits apply to CPT 97551? +
No NCCI PTP edits currently on file for this code.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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