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See a sample rate comparisonCPT 97016 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Application Of A Modality To O, Application Of A Modality To One Or More Areasvasopneumatic Devices Application Of A Modality To One Or More Areas
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Physical Medicine and Rehabilitation Evaluations |
| Common Place of Service | 11 - Office 49 - Independent Clinic |
| Common Modifiers | GP - Services delivered under an outpatient physical therapy plan of care CQ - PT services by assistant |
| Complexity Level | Low |
| Medicare Fee Schedule | $12.02 national non-facility rate (2026) · View Medicare rates for 97016 |
| Medicaid Fee Schedule | $11.05 median of the 7 states in the free preview · View Medicaid rates for 97016 |
National average reimbursement for CPT 97016 by major payers:
$20.43
$14.93
$15.05
$15.07
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CPT 97016
5 of 25 sample ratesHigher to lower in this preview
Michael Mijares
$75.56Published rateSamuel Young
Albemarle Physicians Services, Inc.
$18.36Published rateBradley Homan
Celebration Orthopaedic & Sports Medicine Institute, P.A.
$13.50Published ratePodiatry International, Inc.
Podiatry International Inc
$10.23Published rateDeepika Ratnala
Certified Foot Ankle Specialists
$7.78Published rate
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See a sample payer proposalCPT 97016 vs. Other Physical Medicine and Rehabilitation Evaluations Codes
The CPT 97016 code is part of the Medicine Services and Procedures services used for Physical Medicine and Rehabilitation Evaluations. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 97016 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 97014-CPT | Low | Application Of A Modality To O, Application Of A Modality To One Or More Areas Electricalstimulation(Unattended) Application Of A Modality To One Or More Areas Electrical |
| 97016-CPT | Low | Application Of A Modality To O, Application Of A Modality To One Or More Areasvasopneumatic Devices Application Of A Modality To One Or More Areas |
| 97018-CPT | Low | Application Of A Modality To O, Application Of A Modality To One Or More Areas Paraffinbath Application Of A Modality To One Or More Areas Paraffin |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 97016. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 97016 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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