What is Re-evaluation for Physical Therapy (CPT 97164)?

Re-evaluation for physical therapy, typically 20 minutes. This clinical code is utilized across practices and hospitals for diagnostic and therapeutic service documentation.

What do doctors typically charge for Re-evaluation for Physical Therapy?

The nationwide median physician charge for Re-evaluation for Physical Therapy (CPT 97164) is $105.00. Doctor billed charges vary based on geographic region, setting, and overhead.

What is the standard insurance baseline for CPT 97164?

The standard insurance baseline reimbursement rate is $69.22. This represents the customary allowable amount established across standard fee schedules.

Home/Procedures/Re-evaluation for Physical Therapy

CPT 97164Medical Service

Re-evaluation for Physical Therapy

Re-evaluation for physical therapy, typically 20 minutes. Clinical pricing breakdown and utilization metrics across 9,023 practicing doctors nationwide.

$105.00

Peer Median Charge

Gross billed rate

$69.22

Standard Baseline

Customary allowable

1.5x

National Markup

Charge vs baseline

9,023

Active Physicians

Billing this code

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Understanding This Medical Fee

Gross Charge vs Negotiated Payment: The median physician charge for this service is $105.00. However, insured patients almost never pay this full amount directly. Insurers negotiate rates down toward the $69.22 baseline.

Self-Pay & Uninsured Guidance: If you are paying without insurance or out-of-network, request a prompt-pay cash discount. Most medical practices are willing to settle self-pay bills near the customary baseline rate rather than the full gross charge.

Key Questions for Your Doctor's Billing Office:

"Does Dr. [Name] participate in my specific insurance plan network?"
"What is the total self-pay or cash rate for code 97164 if paid upfront?"
"Are there separate facility, anesthesia, or pathology fees associated with this procedure?"