CPT 97170 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.

Athletic Training Evaluation Moderate Complexity Requiring These Components: A Medical History And Physical Activity Profile With 1-2 Comorbi- Dities That Affect Physical Activity; An Examina- Tion Of Affected Body Area And Other Symptomatic Or Related Systems Addressing A Total Of 3 Or Moreelements From Any Of The Following: Body Struc- Tures Physical Activity And/Or Participation Deficiencies; And Clinical Decision Making Of Mo- Deratecomplexity Using Standardized Patient Asses

Key Fact	Detail
Service Type	• Medicine Services and Procedures • Physical Medicine and Rehabilitation Evaluations
Common Place of Service	• 11 - Office • 10 - Telehealth in Patient's Home
Common Modifiers	• None • 59 - Distinct Procedural Service • GO - Services delivered under an outpatient occupational therapy plan of care
Complexity Level	Low

National average reimbursement for CPT 97170 by major payers:

$58.28

$57.41

$42.35

$71.73

Preview provider-level rates for...

For billing codeCPT 97170

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 97170
United	97170	$50.20	1790214674 - JENNIFER HARKEY	363149833 - NORTHWESTERN MEMORIAL HEALTHCARE	IL	Psychiatry Physician (2084P0800X)
United	97170	$53.02	1265753867 - ASIFA CHOUDHRY	850703768 - (IL) CARLE WEST PHYSICIAN GROUP INC	IL	Psychiatry Physician (2084P0800X)
United	97170	$55.59	1225211600 - JOHN MILLICHAP	383852646 - OSF MULTI-SPECIALTY GROUP	CO	Neurology with Special Qualifications in Child Neurology Physician (2084N0402X)
United	97170	$99.22	1467802108 - MIRIAM BALTUANO SONGHURST	440605373 - CHILDRENS MERCY HOSPITAL	OK	Neurology with Special Qualifications in Child Neurology Physician (2084N0402X)
United	97170	$48.38	1518037126 - MARY LAKE	364187449	IL	Child & Adolescent Psychiatry Physician (2084P0804X)
United	97170	$56.97	1275564197 - PAUL BERKOWITZ	842494027 - BRIGHTSIDE MEDICAL	IN	Psychiatry Physician (2084P0800X)
United	97170	$183.08	1386969079 - ADAM WALLACE	391678306 - AURORA MEDICAL GROUP INC	MN	Neurology with Special Qualifications in Child Neurology Physician (2084N0402X)
United	97170	$77.48	1760412621 - RHONDA LAMPEN	911352172 - MULTICARE HEALTH SYSTEM	IL	Psychiatry Physician (2084P0800X)
United	97170	$53.68	1760412621 - RHONDA LAMPEN	364015560 - LOYOLA UNIVERSITY MEDICAL CENTER	CA	Psychiatry Physician (2084P0800X)
United	97170	$53.68	1407807746 - SYED KHAN	364015560 - LOYOLA UNIVERSITY MEDICAL CENTER	IL	Psychiatry Physician (2084P0800X)
United	97170	$103.41	1942494018 - SANTOSH SHRESTHA	364143823 - SIU PHYSICIANS & SURGEONS INC	IL	Psychiatry Physician (2084P0800X)
United	97170	$46.83	1134127301 - BAYCARE HOME CARE, INC.	593582520 - (FL) BAYCARE HOME CARE INC	FL	Home Health Agency (251E00000X)
United	97170	$105.48	1003869553 - MALEEHA AHSAN	362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION	IL	Psychiatry Physician (2084P0800X)
United	97170	$105.48	1255892808 - ASHLEY SHI	362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION	IL	Psychiatry Physician (2084P0800X)
United	97170	$59.06	1679540595 - JOSEPH MCNALLY	461186809 - (IL) MCNALLY AND GARA PSYCHIATRIC SOLUTIONS LLC	IL	Psychiatry Physician (2084P0800X)
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 97170 vs. Other Physical Medicine and Rehabilitation Evaluations Codes

The CPT 97170 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 97170 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
97169-CPT	Low	Athletic Training Evaluation Low Complexity Requiring These Components: A History And Phy- Sicalactivity Profile With No Comorbidities That Affect Physical Activity; An Examination Of Af- Fected 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 Low Complexity Using Standardized Patient Assessment Instrument
97170-CPT	Low	Athletic Training Evaluation Moderate Complexity Requiring These Components: A Medical History And Physical Activity Profile With 1-2 Comorbi- Dities That Affect Physical Activity; An Examina- Tion Of Affected Body Area And Other Symptomatic Or Related Systems Addressing A Total Of 3 Or Moreelements From Any Of The Following: Body Struc- Tures Physical Activity And/Or Participation Deficiencies; And Clinical Decision Making Of Mo- Deratecomplexity Using Standardized Patient Asses
97171-CPT	Low	Athletic Training Evaluation High Complexity Requiring These Components: A Medical History And Physical Activity Profile With 3 Or More Comorbidities That Affect Physical Activity; A Comprehensive Examination Of Body Systems Using Standardized Tests And Measures Addressing A Total Of 4 Or More Elements From Any Of The Following: Body Structures Physical Activity And/Or Participation Deficiencies; Clinical Presentation With

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 97170. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 97170 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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