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See a sample rate comparisonCPT 97169 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.
Athletic Trn Eval Low Cmplx, Athletic Training Evaluation Low Complexity Requiring These Components A History And Physical Activity Profile With No Comorbidities That Affect Physical Activity An Examination Of Affected Body Area And Other Symptomatic Or Related Systems Addressing 1 2 Elements From Any Of The Following Body Structures Physical Activity And Or Participation Deficiencies And Clinical Decision Making Of Low Complexity Using Standardized Patient Assessment Instrument And Or Measurable Assessment Of Functional Outcome Typically 15 Minutes Are Spent Face To Face With The Patient And Or Family
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Physical Medicine and Rehabilitation Evaluations |
| Common Place of Service | 11 - Office 50 - Federally Qualified Health Center |
| Common Modifiers | 59 - Distinct Procedural Service 25 - Significant, separately identifiable E/M service same day |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 97169 |
| Medicaid Fee Schedule | View Medicaid rates for 97169 |
National average reimbursement for CPT 97169 by major payers:
$55.34
$57.41
$41.87
$71.94
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CPT 97169
5 of 25 sample ratesHigher to lower in this preview
Matthew Niedzwiecki
$107.19Published rateDavid Hsu
Bellin Memorial Hospital Inc
$77.77Published rateTrixie Lipke
Beaver Dam Community Hospitals Inc
$52.31Published ratePaul Berkowitz
Presence Healthcare Services
$50.20Published rateSunrise Home Health Care Inc.
Sunrise Home Health Care Inc
$23.34Published rate
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See a sample payer proposalCPT 97169 vs. Other Physical Medicine and Rehabilitation Evaluations Codes
The CPT 97169 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 97169 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 |
|---|---|---|
| 97168-CPT | Low | Ot Re Eval Est Plan Care, Re Evaluation Of Occupational Therapy Established Plan Of Care Requiring These Components An Assessment Of Changes In Patient Functional Or Medical Status With Revised Plan Of Care An Update To The Initial Occupational Profile To Reflect Changes In Condition Or Environment That Affect Future Interventions And Or Goals And A Revised Plan Of Care A Formal Reevaluation Is Performed When There Is A Documented Change In Functional Status Or A Significant Change To The Plan Of Care Is Required Typically 30 Minutes Are Spent Face To Face With The Patient And Or Family |
| 97169-CPT | Low | Athletic Trn Eval Low Cmplx, Athletic Training Evaluation Low Complexity Requiring These Components A History And Physical Activity Profile With No Comorbidities That Affect Physical Activity An Examination Of Affected Body Area And Other Symptomatic Or Related Systems Addressing 1 2 Elements From Any Of The Following Body Structures Physical Activity And Or Participation Deficiencies And Clinical Decision Making Of Low Complexity Using Standardized Patient Assessment Instrument And Or Measurable Assessment Of Functional Outcome Typically 15 Minutes Are Spent Face To Face With The Patient And Or Family |
| 97170-CPT | Low | Athletic Trn Eval Mod Cmplx, Athletic Training Evaluation Moderate Complexity Requiring These Components A Medical History And Physical Activity Profile With 1 2 Comorbidities That Affect Physical Activity An Examination Of Affected Body Area And Other Symptomatic Or Related Systems Addressing A Total Of 3 Or More Elements From Any Of The Following Body Structures Physical Activity And Or Participation Deficiencies And Clinical Decision Making Of Moderate Complexity Using Standardized Patient Assessment Instrument And Or Measurable Assessment Of Functional Outcome Typically 30 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 97169. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 97169 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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