CPT 97172 Fee Schedule

Last Verified: July 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	Physical Medicine and Rehabilitation Therapeutic Procedures Physical Medicine and Rehabilitation Evaluations
Common Place of Service	11 - Office 20 - Urgent Care Facility
Common Modifiers	None 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

National average reimbursement for CPT 97172 by major payers:

$35.96

$28.73

$23.48

$40.47

Preview provider-level rates for...

For billing codeCPT 97172

Payer	Code	Rate	NPI	Tax ID	State	Specialty
United	97172	$25.10	1225171614 - RUBEENA MIAN	362709982 - (IL) PRESENCE BEHAVIORAL HEALTH	IL	Psychiatry Physician (2084P0800X)
United	97172	$26.14	1356608988 - TRIXIE LIPKE	391157876 - BEAVER DAM COMMUNITY HOSPITALS INC	IL	Psychiatry Physician (2084P0800X)
United	97172	$25.10	1801835202 - CHICAGO NEUROLOGY GROUP SC	113666848 - (IL) CHICAGO NEUROLOGY GROUP, S.C.	IL	Psychiatry Physician (2084P0800X)
United	97172	$26.84	1962664789 - JAMIE EVANS	364015560 - LOYOLA UNIVERSITY MEDICAL CENTER	IL	Psychiatry Physician (2084P0800X)
United	97172	$27.37	1245252303 - MARY FAHRMEIER	364015560 - LOYOLA UNIVERSITY MEDICAL CENTER	VA	Psychiatry Physician (2084P0800X)
United	97172	$25.10	1922481530 - THOMAS LOBUR	362709982 - (IL) PRESENCE BEHAVIORAL HEALTH	IL	Psychiatry Physician (2084P0800X)
United	97172	$24.19	1760419311 - PETER HEYDEMANN	363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN	IL	Neurology with Special Qualifications in Child Neurology Physician (2084N0402X)
United	97172	$24.14	1023112745 - NELDA AKINBILE	366006541 - (IL) VETERANS ASSISTANCE COMMISSION C	IL	Psychiatry Physician (2084P0800X)
United	97172	$27.67	1679526784 - ELTON SMITH	911031583	VA	Psychiatry Physician (2084P0800X)
United	97172	$44.84	1104082734 - JADA JOHNSON	362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION	IL	Psychiatry Physician (2084P0800X)
United	97172	$53.59	1962664789 - JAMIE EVANS	910844563	VA	Psychiatry Physician (2084P0800X)
United	97172	$28.14	1982870317 - LUDA SORIN	383852646 - OSF MULTI-SPECIALTY GROUP	IL	Neurology with Special Qualifications in Child Neurology Physician (2084N0402X)
United	97172	$25.10	1063905339 - KATHRYN ABELL	363149833 - NORTHWESTERN MEMORIAL HEALTHCARE	IL	Psychiatry Physician (2084P0800X)
United	97172	$41.99	1467802108 - MIRIAM BALTUANO SONGHURST	863284696 - OU HEALTH PARTNERS INC	OK	Neurology with Special Qualifications in Child Neurology Physician (2084N0402X)
United	97172	$52.75	1669678009 - NADIA MIRZA	362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION	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 97172 vs. Other Physical Medicine and Rehabilitation Evaluations Codes

The CPT 97172 code is part of the Physical Medicine and Rehabilitation Therapeutic 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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