CPT 97163 Fee Schedule

Last Verified: January 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.

Physical Therapy Evaluation: High Complexity Requiring These Components: A History Of Present Problem With 3 Or More Personal Factors And/Or Comorbidities That Impact The Plan Of Care; An Examination Of Body Systems Using Standardized Tests And Measures Addressing A Total Of 4 Or Moreelements From Any Of The Following: Body Struc- Tures And Functions Activity Limitations And/Or Participation Restrictions; A Clinical Presenta- Tion With Unstable And Unpredictable Characteristi

Key Fact	Detail
Service Type	• Medicine Services and Procedures • Physical Medicine and Rehabilitation Evaluations
Common Place of Service	• 11 - Office • None
Common Modifiers	• None • GP - Services delivered under an outpatient physical therapy plan of care • KX - Requirements specified in the medical policy have been met
Complexity Level	Low

National average reimbursement for CPT 97163 by major payers:

$93.46

$89.93

$90.85

$109.83

Preview provider-level rates for...

For billing codeCPT 97163

Payer	Code	Rate	NPI	Tax ID	State	Specialty
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 97163
United	97163	$84.00	1669466884 - SULTANA RAZIA	200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC	NY	Hematology & Oncology Physician (207RH0003X)
United	97163	$84.00	1770577884 - THOMAS JOHN	200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC	NY	Internal Medicine Physician (207R00000X)
United	97163	$76.55	1477226835 - MORGAN MURAWSKI	200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC	NY	Pediatric Nurse Practitioner (363LP0200X)
United	97163	$128.69	1134113343 - SHELLY HEARN	200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC	NY	Family Medicine Physician (207Q00000X)
United	97163	$76.55	1649289430 - MARCY GAMBINO	200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC	NY	Medical Physician Assistant (363AM0700X)
United	97163	$96.47	1194255265 - BREANNA OLDEN	840786058 - (CO) PANORAMA ORTHOPEDICS AND SPINE CENTER, PC	CO	Occupational Therapist (225X00000X)
United	97163	$243.27	1902097462 - RHONDA BELLAVIA	840631509	CO	Specialist (174400000X)
United	97163	$128.69	1942294095 - JOHN SULLIVAN	200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC	NY	Orthopaedic Surgery Physician (207X00000X)
United	97163	$91.02	1437404324 - LAUREN BOGGS	60851044 - (CT) ORTHOCONNECTICUT, PC	CO	Physical Therapist (225100000X)
United	97163	$84.00	1982043386 - AILEEN CALLAN	200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC	NY	Family Nurse Practitioner (363LF0000X)
United	97163	$84.00	1174360945 - ASHLEY FAHY	200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC	NY	Family Nurse Practitioner (363LF0000X)
United	97163	$89.44	1841918117 - MEGAN DOYLE	840614901 - (CO) BOULDERCENTRE FOR ORTHOPEDICS, P.C.	CO	Physical Therapist (225100000X)
United	97163	$85.91	1609810266 - CURTIS BECKER	541288882 - (VA) SPORTS MEDICINE & ORTHOPAEDIC CENTER, INC.	CO	Physical Therapist (225100000X)
United	97163	$76.55	1184616039 - RAPHAEL ALCURI	200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC	NY	Diagnostic Radiology Physician (2085R0202X)
United	97163	$84.00	1891789947 - JULIA ROSS	200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC	NY	Nurse Practitioner (363L00000X)
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist

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CPT 97163 vs. Other Physical Medicine and Rehabilitation Evaluations Codes

The CPT 97163 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 97163 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
97162-CPT	Low	Physical Therapy Evaluation: Moderate Complexity Requiring These Components: A History Of Present Problem With 1-2 Personal Factors And/Or Comorbi- Dities That Impact The Plan Of Care; An Examina- Tion Of Body Systems Using Standardized Tests And Measures Addressing A Total Of 3 Or More Elements From Any Of The Following: Body Struc--Retures And Functions Activity Limitations And/Orparticipation Restrictions; An Evolving Clinical Presentation With Changing Characteristics; And
97163-CPT	Low	Physical Therapy Evaluation: High Complexity Requiring These Components: A History Of Present Problem With 3 Or More Personal Factors And/Or Comorbidities That Impact The Plan Of Care; An Examination Of Body Systems Using Standardized Tests And Measures Addressing A Total Of 4 Or Moreelements From Any Of The Following: Body Struc- Tures And Functions Activity Limitations And/Or Participation Restrictions; A Clinical Presenta- Tion With Unstable And Unpredictable Characteristi
97164-CPT	Low	Re-Evaluation Of Physical Therapy Established Planof Care Requiring These Components: An Examina- Tionincluding A Review Of History And Use Of Standardized Tests And Measures Is Required;And Revised Plan Of Care Using Standardized Patient Assessment Instrument And/Or Measurable Assessmentof Functional Outcome Typically 20 Minutes Are Spent Face-To -Face With The Patient And/Or Family

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 97163. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 97163 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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