#1257 of 11K

97164

PT re-evaluation

PT re-evaluation is the #1,257 most-billed Medicaid procedure code, with $30.8M in payments across 791K claims from 2018–2024. The national median cost per claim is $32.66. Costs vary widely — the 90th percentile is $75.00 per claim, 2.3× the median.

Total Paid

$30.8M

0.00% of all spending

Total Claims

791K

Providers

Avg Cost/Claim

$39

National Cost Distribution

How much do providers bill per claim for 97164? Based on 2K providers billing this code nationally.

Median

$32.66

Average

$39.28

Std Dev

$30.90

Max

$373.45

Percentile Distribution (Cost per Claim)

p10

$11.24

p25

$22.79

Median

$32.66

p75

$47.22

p90

$75.00

p95

$96.85

p99

$144.02

50% of providers bill between $22.79 and $47.22 per claim for this code.

90% bill between $11.24 and $75.00.

Top 1% bill above $144.02.

About This Procedure

HCPCS code 97164 (PT re-evaluation) was billed by 2K providers across 791K claims, totaling $30.8M in Medicaid payments from 2018–2024. This code was used for 664K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$32.66

Providers Billing

National Spending

$30.8M

Avg/Median Ratio

1.20×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 97164

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Ahava Medical And Rehabilitation Center, Llc Brooklyn, NY · Rehabilitation Practitioner	$1.6M	$80.95	2.5× median	Top 10%
2	1487740957	$611K	$236.14	7.2× median	Top 1%
3	Bronxcare Health System Bronx, NY · General Acute Care Hospital	$571K	$107.48	3.3× median	Top 10%
4	Variety Children's Hospital Miami, FL · General Acute Care Hospital Children	$568K	$373.45	11.4× median	Top 1%
5	1104120385	$518K	$39.04	1.2× median	Above Median
6	1659485936	$514K	$36.79	1.1× median	Above Median
7	1235390899	$397K	$32.97	1.0× median	Above Median
8	1134152861	$369K	$36.66	1.1× median	Above Median
9	1073746533	$367K	$42.06	1.3× median	Above Median
10	New York Network Ipa Inc Brooklyn, NY · Exclusive Provider Organization	$303K	$37.05	1.1× median	Above Median
11	Children's Hospital Medical Center Cincinnati, OH · Clinic/Center, Primary Care	$262K	$98.10	3.0× median	Top 10%
12	1164851085	$253K	$32.66	1.0× median	Above Median
13	1528061827	$242K	$64.01	2.0× median	Above 75th
14	1912463399	$241K	$21.63	0.7× median	Below Median
15	Adventist Health System-sunbelt, Inc Orlando, FL · Ambulance, Land Transport	$232K	$78.39	2.4× median	Top 10%
16	University Of Rochester Rochester, NY · General Acute Care Hospital	$228K	$96.71	3.0× median	Top 10%
17	1194722801	$221K	$26.18	0.8× median	Below Median
18	Johns Hopkins All Children's Hospital Inc St Petersburg, FL · General Acute Care Hospital Children	$220K	$257.47	7.9× median	Top 1%
19	1679098628	$219K	$40.59	1.2× median	Above Median
20	1922180264	$216K	$85.41	2.6× median	Top 10%

Showing top 20 of 2K providers billing this code

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