{
    "code": "97164",
    "coding_system": "CPT",
    "canonical_url": "https://localishealth.com/cpt/97164/2021/A",
    "release_specific_url": "https://localishealth.com/cpt/97164/2021/D",
    "description": "A formal reassessment partway through a course of physical therapy, as opposed to a fresh initial evaluation. The therapist repeats the key measurements, compares them against the starting point, and revises the plan of care accordingly. It is meant for moments when something has actually changed — progress has stalled, the patient has worsened, or a new problem has surfaced — not as a routine note attached to every visit.",
    "answer": {
        "question": "How much did Medicare pay for CPT 97164 in Q4 2021?",
        "text": "Medicare paid $69.79 for CPT 97164 in the office (non-facility) setting and $69.79 in a facility under the Q4 2021 Physician Fee Schedule, effective October 2021. These are the national allowed amounts before the ~2% sequestration cut and before locality (GPCI) adjustment. This price has been unchanged since Q1 2021, when it increased 15.8%."
    },
    "release": {
        "schedule": "pfs",
        "year": 2021,
        "quarter": "D",
        "label": "Q4 2021",
        "effective": "October 1 – December 31, 2021",
        "revision": 1
    },
    "status": {
        "code": "A",
        "non_facility_payable": true,
        "facility_payable": true
    },
    "national_rates_usd": {
        "office_non_facility": 69.79,
        "facility": 69.79,
        "sequestration_applied": false,
        "gpci": 1
    },
    "rvus": {
        "work": 0.96,
        "practice_expense_non_facility": 1,
        "practice_expense_facility": 1,
        "malpractice": 0.04
    },
    "formula": "(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor",
    "conversion_factor": 34.8931,
    "source": {
        "label": "Physician relative value file (Q4 2021)",
        "cms_url": "https://www.cms.gov/files/zip/rvu21d.zip",
        "local_source_url": "https://localishealth.com/sources/physician-fee-schedule/2021/D",
        "file": "PPRRVU21_OCT.csv",
        "row": 17151,
        "sha256": "f1972bd23bdc51795ceba7d536bb413a0ba0b47fad8c2ed594e7ee7799877297"
    },
    "modified_at": "2026-08-04T03:10:59+00:00"
}