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See a sample rate comparisonCPT 97116 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.
Therapeutic Procedure One Or, Therapeutic Procedure One Or More Areas Each 15 Minutesgait Training (Includes Stair Climbing) Therapeutic Procedure One Or More Areas Each 15 Minutes
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Physical Medicine and Rehabilitation Evaluations |
| Common Place of Service | 11 - Office |
| Common Modifiers | GP - Services delivered under an outpatient physical therapy plan of care KX - Requirements specified in the medical policy have been met |
| Complexity Level | Low |
| Medicare Fee Schedule | $29.06 national non-facility rate (2026) · View Medicare rates for 97116 |
| Medicaid Fee Schedule | $23.49 median of the 7 states in the free preview · View Medicaid rates for 97116 |
National average reimbursement for CPT 97116 by major payers:
$34.81
$29.31
$27.34
$30.81
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CPT 97116
5 of 25 sample ratesHigher to lower in this preview
Stephanie Higby
Slocum Dickson Medical Group PLLC
$37.77Published rateCelesta Hunsiker
Slocum Dickson Medical Group PLLC
$27.12Published rateScott Peplinski
Slocum Dickson Medical Group PLLC
$27.12Published rateSarah Rosario
Slocum Dickson Medical Group PLLC
$16.00Published rateTatyana Antonevich
Slocum Dickson Medical Group PLLC
$16.00Published rate
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See a sample payer proposalCPT 97116 vs. Other Physical Medicine and Rehabilitation Evaluations Codes
The CPT 97116 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 97116 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 |
|---|---|---|
| 97113-CPT | Low | Therapeutic Procedure One Or, Therapeutic Procedure One Or More Areas Each 15 Minutesaquatic Therapy With Therapeutic Exercisestherapeutic Procedure One Or More Areas Each 1 5 Minutes |
| 97116-CPT | Low | Therapeutic Procedure One Or, Therapeutic Procedure One Or More Areas Each 15 Minutesgait Training (Includes Stair Climbing) Therapeutic Procedure One Or More Areas Each 15 Minutes |
| 97124-CPT | Low | Therapeutic Procedure One Or, Therapeutic Procedure One Or More Areas Each 15 Minutesmassage Including Effleurage Petrissage Andor Tapotement (Stroking Compression Percussion) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 97116. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 97116 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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