Billing code 97164: PT re-evaluationMedicare rate & RVUs

Medicare pays $67.47 for 97164 nationally in the office. Local office rates run $62.36–$86.34.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 97164 covers

A physical therapist uses this service to reassess a patient who already has an established physical therapy plan of care. The re-evaluation may include reviewing the patient’s history, examining current impairments and function, and using appropriate tests or measures to determine whether the plan needs revision. It is distinct from routine monitoring during treatment and from an initial physical therapy evaluation. It is commonly performed in an outpatient therapy clinic, including for patients whose mobility or function has changed during rehabilitation or who are not progressing as expected.

Report 97164 when the reassessment supports a revised plan of care, with documentation of the current findings, the reason for re-evaluation, and any resulting changes to goals or treatment. It is not a timed treatment unit. CMS treats this as a therapy service without a separate professional component, so it is reported without modifier 26. When multiple therapy units are reported for the same day, CMS reduces the practice expense for the second and later units.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 97164 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

97164 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 97164 rate is calculated

Each of 97164’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 97164

The CMS indicators that decide how 97164 is paid alongside other services.

What modifiers do to the payment

97164 compared with similar codes

How to choose

97162PT evaluation

97162 is an initial physical therapy evaluation at moderate complexity. Use 97164 when the patient already has an established physical therapy plan and needs reassessment.

97163PT evaluation

97163 is an initial physical therapy evaluation at high complexity; its complexity level does not make it a substitute for re-evaluation under an established plan.

97168OT reevaluation

97168 is the occupational therapy re-evaluation counterpart. Select the code for the discipline providing the reassessment.

Codes related to 97164

Related codes aren’t interchangeable: bill the code that matches the service performed.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates