Billing code 97164: PT re-evaluationMedicare rate & RVUs in Texas
A physical therapist re-examines a patient under an established plan of care when changed status or response to treatment warrants reassessment and plan revision.
Medicare pays $64.29–$69.53 for 97164 in the office in Texas, from Beaumont to Austin. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
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 in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 payment localities
$64.29 to $69.53
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | $69.53 | Unavailable |
| Beaumont | $64.29 | Unavailable |
| Brazoria | $67.34 | Unavailable |
| Dallas | $67.57 | Unavailable |
| Fort Worth | $67.22 | Unavailable |
| Galveston | $67.42 | Unavailable |
| Houston | $67.61 | Unavailable |
| Rest Of Texas | $65.65 | Unavailable |
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.
How the rate is built · 97164
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.96Practice expense 1.05Malpractice 0.01
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 97164
The CMS indicators that decide how 97164 is paid alongside other services.
CMS payment indicators · 97164
PT re-evaluation
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 5 | Therapy reduction: practice expense of the second and later units is reduced. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 7 | Therapy service: the split doesn’t apply. |
What modifiers do to the payment
Modifier CQ · payment effect
With and without the modifier
97164 without CQ · national office
$67.47
PT re-evaluation
97164-CQ · Allowed amount unchanged
$67.47
Medicare cuts its own payment by 15% after the patient’s 20% coinsurance; the allowed amount stays the same. On $100 allowed: $20 coinsurance, then Medicare pays $68 instead of $80.
97164 compared with similar codes
Compare codes
97164 vs 97162 vs 97163 vs 97168: national Medicare rates
Swap in your local Medicare rate.
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.
97164 billing questions
When should 97164 be reported instead of a physical therapy evaluation code?
Use 97164 for reassessment under an established physical therapy plan of care. Codes 97161–97163 describe initial physical therapy evaluations at different complexity levels.
Does every progress assessment support 97164?
No. The record should show why a re-evaluation was needed, the patient’s current status, and how the findings support any revision to the established plan.
Is 97164 billed in timed units?
No. Report one unit for the re-evaluation service rather than counting 15-minute treatment intervals.
Should modifier 26 be appended?
No. CMS treats 97164 as a therapy service without a separately reported professional component.
How does the therapy multiple procedure reduction affect 97164?
When multiple therapy units are reported on the same day, CMS reduces practice expense for the second and later units.
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
Show the CMS file lines behind this rate
Fee sheets
Put 97164 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →