Top billers · Codes · 97161

Who bills 97161?

97161 is the CPT code for: Evaluation for physical therapy, typically 20 minutes. In 2024, 37,020 providers billed 97161 1,576,730 times, with an estimated $114.9M paid by Medicare.

$97.86
2026 PFS national rate (office)
37,020
Providers billing it (2024)
1,576,730
Services billed
$114.9M
Est. Medicare paid
The fee

What does Medicare pay for 97161?

Medicare's 2026 Physician Fee Schedule national rate for 97161 is $97.86 in the office setting. National amounts before geographic adjustment — your locality's rate differs slightly.

Office (non-facility) rate$97.86
Facility rateNo separate facility rate
Fee schedule2026 Medicare Physician Fee Schedule

What Medicare actually paid per service in 2024, on average: $72.88 (observed payment across all settings and modifiers — not a fee-schedule rate).

The list

Who bills 97161 the most.

The top 5 billers nationally, ranked by 2024 Medicare service volume.

#ProviderSpecialtyLocationServicesEst. Medicare paid
1Ryan Urenda, PTPhysical Therapist in Private PracticeJupiter, FL1,487$109K
2Simon Tan, MDNeurologySouthlake, TX1,086$82K
3Patricia Freire, PTPhysical Therapist in Private PracticeSw Ranches, FL1,015$66K
4Ken Richards, PTPhysical Therapist in Private PracticeVentura, CA918$76K
5Robin Pflieger, PT, DPTPhysical Therapist in Private PracticeNeptune, NJ560$46K

37,015 more providers billed 97161 in 2024. The full ranked list — filtered to your exact territory, with phone numbers and year-over-year history — is one search in Prospect 811.

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The breakdown

Where 97161 gets billed.

Top states by volume

California172,353 services
New York145,739 services
Florida114,380 services
New Jersey70,940 services
Illinois65,862 services
Texas61,677 services
North Carolina56,522 services
Arizona54,392 services

About this code

CMS descriptionEvaluation for physical therapy, typically 20 minutes
Code typeCPT (Level I HCPCS)
Providers billing it (2024)37,020
Services billed (2024)1,576,730
Avg. Medicare payment per service (2024)$72.88
Where these numbers come from. Rates are CMS's own public fee-schedule files — the Physician Fee Schedule, Clinical Laboratory Fee Schedule, ASP drug pricing, DMEPOS, and the OPPS/ASC addenda — each labeled with its file year on this page; national amounts are shown before geographic adjustment. Codes with no separate rate render the fee schedule's own status in words, never a fake $0. Utilization comes from CMS's public Medicare Provider Utilization & Payment data for 2024, the most recent year released. It covers traditional Medicare fee-for-service only (no commercial insurance, no Medicare Advantage), and CMS suppresses any provider-and-code line with fewer than 11 beneficiaries before publishing, so low-volume billers don't appear at all. "Est. Medicare paid" is each billing line's average Medicare payment times its service count, summed — actual per-claim payment varies by setting and modifiers. For drug and supply codes, a "service" is a billed unit (a milligram, a milliliter, a square centimeter), not a patient visit. Code descriptions are CMS's own, from the utilization files. Prospect 811 organizes public data; it doesn't add to or alter it. Not affiliated with or endorsed by CMS. Full detail on the data page.

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