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CPT 97164: Physical Therapy Re-evaluation, 20-Minute Face-to-Face
CPT code 97164 denotes a physical therapy re-evaluation performed by a qualified clinician to reassess body structure, function, and functional status and to revise the plan of care using standardized instruments and outcome measures. It is an important billing category for outpatient rehabilitation because it captures focused reassessment encounters that inform ongoing therapy direction and measurable functional progress. Nationally, accurate use of this code supports documentation of clinical decision-making and continuity of care across common musculoskeletal and functional diagnoses.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical context for 97164, typical sites of service, common associated diagnoses such as low back pain and gait difficulties, and related therapy procedure codes used alongside the re-evaluation. The summary also outlines common modifiers and provider taxonomies associated with physical therapy services and lists related procedure codes frequently billed in the same episode of care.
This publication equips clinicians, coders, and policy professionals with a concise reference to the clinical intent of 97164, its role in care planning and functional measurement, and the payer landscape where this service is commonly reimbursed.
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Billing Code Overview
CPT code 97164 describes a physical therapy re-evaluation performed by a qualified provider, typically a physical therapist. The service includes a review of the patient’s history and the use of standardized tests and measures to assess body structure and function. The provider revises the plan of care using a standardized instrument and a measurable functional outcome assessment tool, with the encounter typically involving 20 minutes of face-to-face time with the patient, the patient’s family, or both.
Service type: Physical therapy re-evaluation
Typical site of service: Outpatient physical therapy or other ambulatory rehabilitation settings where physical therapists provide direct patient care
National Reimbursement Benchmarks
National commercial averages sit above Medicare for CPT 97164: Blue Cross Blue Shield’s mean of $168 and BUCA’s mean of $127 both exceed Medicare’s mean of $70.1, indicating commercial payers generally reimburse at higher levels than Medicare for this service. Cigna ($71.6), Aetna ($69.8), and UnitedHealth Group ($75.3) cluster near Medicare’s mean, while Blue Cross Blue Shield and BUCA pull the overall commercial mean upward.
Dispersion measured as the interquartile range (P75−P25) varies notably across payers. Blue Cross Blue Shield has the widest IQR at $140.5 (P75 $228.5 − P25 $88.0), reflecting substantial variability in commercial contracting. UnitedHealth Group’s IQR is $25.5 and Cigna’s is $36.0, showing tighter distributions; Aetna’s IQR is $44.0. BUCA’s IQR is $59.8 and Medicare’s IQR is $6.0, with Medicare demonstrating the tightest band around its mean.