How much does Medicare pay for CPT 97164?

Medicare allowed an average of $68.54 per service and paid $52.70 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $121.17, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 97164?

Re-evaluation for physical therapy, typically 20 minutes. It was billed 419,682 times to 256,120 Medicare beneficiaries by 8,672 providers in 2024.

Which specialty bills 97164 most?

Physical Therapist in Private Practice, with 414,775 services from 8,558 clinicians. Next are Physical Medicine and Rehabilitation, Orthopedic Surgery, Family Practice.

CPT 97164

Re-evaluation for physical therapy, typically 20 minutes

$68.54Medicare-allowed amount per service, averaged across 419,682 services

Providers submitted

$121.17

Asking price, not received

Medicare allowed

$68.54

The fee schedule figure

Medicare paid

$52.70

Balance is patient coinsurance

Providers submitted an average of $121.17 for this code and Medicare allowed $68.54 — 1.8× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $52.70 (77%); the rest is the patient’s coinsurance and deductible.

Services: 419,682
Beneficiaries: 256,120
Providers billing it: 8,672
Total allowed: $28,765,004

What Medicare pays for CPT 97164

Across 419,682 services billed by 8,672 providers to 256,120 beneficiaries, Medicare allowed an average of $68.54 per service. That is 1.6 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 97164

Specialty	Services	Beneficiaries	Avg allowed	Providers
Physical Therapist in Private Practice	414,775	253,011	$68.54	8,558
Physical Medicine and Rehabilitation	1,761	1,223	$70.13	40
Orthopedic Surgery	1,086	761	$67.62	27
Family Practice	401	205	$65.76	8
Podiatry	329	192	$69.49	6
Pain Management	283	102	$71.59	4
Internal Medicine	261	107	$76.17	4
Nurse Practitioner	236	102	$51.42	3
Neurology	98	66	$67.01	3
Anesthesiology	84	54	$69.51	2
Occupational Therapist in Private Practice	74	58	$76.91	3
Interventional Pain Management	55	42	$71.93	2
Rheumatology	49	39	$72.02	2
General Practice	49	34	$75.86	2
Sports Medicine	41	36	$71.01	2

97164 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	45,899	$73.19	$52.11	1,027
Maryland	36,661	$72.33	$52.49	558
New Jersey	36,049	$73.58	$52.75	665
Texas	31,631	$65.61	$52.07	518
Pennsylvania	30,034	$68.07	$52.76	584
New York	27,644	$72.56	$52.43	620
Florida	20,708	$67.54	$52.88	377
Arizona	19,136	$66.54	$52.03	422
Massachusetts	15,901	$71.92	$52.22	324
Virginia	11,991	$68.20	$52.18	213
Ohio	11,261	$65.32	$52.82	267
Colorado	10,262	$69.32	$51.62	243
North Carolina	9,360	$61.23	$52.23	210
Illinois	8,565	$68.34	$52.60	187
Louisiana	6,627	$63.62	$53.13	104
Kentucky	6,294	$63.03	$52.84	137
Iowa	6,213	$64.84	$52.47	153
Washington	6,207	$69.50	$51.68	187
Tennessee	5,353	$63.94	$52.26	118
South Carolina	5,282	$65.09	$52.16	87
Missouri	4,939	$63.59	$52.84	89
Michigan	4,846	$43.96	$37.98	157
Delaware	4,549	$68.35	$52.76	83
Indiana	4,510	$65.75	$52.53	100
Georgia	4,117	$64.09	$51.92	90
Hawaii	3,573	$71.81	$52.80	83
Nevada	3,083	$51.31	$39.66	75
Connecticut	3,002	$71.51	$52.25	61
Nebraska	2,736	$64.92	$52.53	62
Kansas	2,585	$64.12	$52.83	47
Oregon	2,388	$67.41	$51.29	71
West Virginia	2,368	$64.54	$52.75	56
Mississippi	2,225	$62.16	$52.60	39
Arkansas	2,169	$62.86	$52.63	47
Maine	2,032	$67.76	$52.60	56
Alabama	1,955	$62.46	$52.28	56
Wisconsin	1,813	$66.56	$52.28	64
Utah	1,805	$64.98	$52.68	56
New Hampshire	1,587	$68.88	$52.15	41
Rhode Island	1,473	$68.44	$52.55	40
New Mexico	1,362	$63.73	$52.29	26
Vermont	1,345	$65.10	$49.33	35
Idaho	1,207	$62.83	$51.60	30
Wyoming	1,205	$67.51	$50.95	33
District of Columbia	1,202	$75.35	$53.24	27
Minnesota	1,086	$67.97	$52.13	34
Oklahoma	1,028	$61.99	$52.13	27
Montana	688	$67.38	$51.30	28
Alaska	578	$80.18	$52.70	17
Puerto Rico	474	$66.75	$53.47	17
South Dakota	273	$67.31	$51.09	13
North Dakota	226	$67.40	$50.03	8
U.S. Virgin Islands	175	$69.38	$53.44	3

Related codes

97110Therapy procedure$22.78
97112Therapy procedure to re-educate brain-to-nerve-to-muscle function$27.06
97140Therapy procedure$20.62
97116Therapy procedure for walking training$21.87
97150Therapy procedure in a group setting$13.60
97161Evaluation for physical therapy$99.49
97162Evaluation for physical therapy$99.21
97113Therapy procedure$27.67
97130Therapy procedure for a range of mental processes$21.18
97124Therapy procedure$25.23
97129Therapy procedure for a range of mental processes$21.82
97163Evaluation for physical therapy$99.08

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.