CPT 97164 reports a physical therapy re-evaluation of an established plan of care, typically about 30 minutes, used when there is a significant change in clinical status.
When to use 97164
Use 97164 to re-evaluate an existing PT plan of care when the patient’s status has significantly changed. Initial evaluations use 97161–97163.
How to bill it
Report per re-evaluation, documenting the significant change that justifies a new assessment rather than routine progress.
Common pitfalls
- Billing a re-eval (97164) for a routine follow-up without a significant change.
- Confusing re-evaluation with an initial evaluation code.
Frequently asked questions
When is 97164 appropriate?
Use 97164 when a significant change in clinical status warrants a new PT assessment of an established plan of care.
Can 97164 be billed routinely each visit?
No. Re-evaluation is reserved for significant changes, not routine treatment visits.