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See a sample rate comparisonCPT 97172 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 Re Eval Plan Cr, Re Evaluation Of Athletic Training Established Plan Of Care Requiring These Components An Assessment Of Patient S Current Functional Status When There Is A Documented Change And A Revised Plan Of Care Using A Standardized Patient Assessment Instrument And Or Measurable Assessment Of Functional Outcome With An Update In Management Options Goals And Interventions Typically 20 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 20 - Urgent Care Facility |
| Common Modifiers | GP - Services delivered under an outpatient physical therapy plan of care 25 - Significant, separately identifiable E/M service same day 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 97172 |
| Medicaid Fee Schedule | View Medicaid rates for 97172 |
National average reimbursement for CPT 97172 by major payers:
$35.96
$28.73
$23.48
$40.47
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CPT 97172
5 of 25 sample ratesHigher to lower in this preview
Jamie Evans
$53.59Published rateMalcolm Vandrevala
Advocate Health And Hospitals Corporation
$42.40Published rateDavid Hanrahan
Loyola University Medical Center
$27.37Published rateKathryn Abell
Northwestern Memorial Healthcare
$25.10Published rateBaycare Home Care, Inc.
Baycare Home Care Inc
$23.42Published rate
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See a sample payer proposalCPT 97172 vs. Other Physical Medicine and Rehabilitation Evaluations Codes
The CPT 97172 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 97172 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 |
|---|---|---|
| 97171-CPT | Low | Athletic Trn Eval High Cmplx, 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 Unstable And Unpredictable Characteristics And Clinical Decision Making Of High Complexity Using Standardized Patient Assessment Instrument And Or Measurable Assessment Of Functional Outcome Typically 45 Minutes Are Spent Face To Face With The Patient And Or Family |
| 97172-CPT | Low | Athletic Trn Re Eval Plan Cr, Re Evaluation Of Athletic Training Established Plan Of Care Requiring These Components An Assessment Of Patient S Current Functional Status When There Is A Documented Change And A Revised Plan Of Care Using A Standardized Patient Assessment Instrument And Or Measurable Assessment Of Functional Outcome With An Update In Management Options Goals And Interventions Typically 20 Minutes Are Spent Face To Face With The Patient And Or Family |
| 97530-CPT | Low | Activity Therapy, Activity Therapy Provided One-On-One To Improve A Persons Ability To Participate In Or Perform Daily Physical Social Or Other Life Activities. The Therapy Includes Active Body Movements Such As Lifting Reaching Or Bending. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 97172. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 97172 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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