How Much Does Patient Re-evaluation Established Plan Care Cost?
Also known as: Pt re-eval est plan care (CPT 97164)
Patient Re-evaluation Established Plan Care (CPT 97164) costs $67 at Medicare rates.
Procedures Commonly Done Together
These procedures are frequently performed alongside Pt re-eval est plan care
Pt re-eval est plan care Cost by Location
Medicare-adjusted rates across CMS localities
| Location | Medicare Rate | Est. Commercial |
|---|---|---|
| AK — ALASKA | $86 | $112 — $172 |
| AL — ALABAMA | $63 | $82 — $127 |
| AR — ARKANSAS | $63 | $81 — $125 |
| AZ — ARIZONA | $67 | $87 — $133 |
| CA — BAKERSFIELD | $72 | $93 — $143 |
| CA — CHICO | $72 | $93 — $143 |
| CA — EL CENTRO | $72 | $93 — $143 |
| CA — FRESNO | $72 | $93 — $143 |
| CA — HANFORD-CORCORAN | $72 | $93 — $143 |
| CA — LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) | $75 | $98 — $151 |
| CA — MADERA | $72 | $93 — $143 |
| CA — MERCED | $72 | $93 — $143 |
| CA — MODESTO | $72 | $93 — $143 |
| CA — NAPA | $81 | $105 — $162 |
| CA — OXNARD-THOUSAND OAKS-VENTURA | $75 | $98 — $150 |
| CA — REDDING | $72 | $93 — $143 |
| CA — REST OF CALIFORNIA | $72 | $93 — $143 |
| CA — RIVERSIDE-SAN BERNARDINO-ONTARIO | $72 | $93 — $143 |
| CA — SACRAMENTO-ROSEVILLE-FOLSOM | $75 | $97 — $149 |
| CA — SALINAS | $74 | $97 — $149 |
| CA — SAN DIEGO-CHULA VISTA-CARLSBAD | $76 | $98 — $151 |
| CA — SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) | $85 | $111 — $170 |
| CA — SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) | $85 | $111 — $170 |
| CA — SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) | $87 | $113 — $174 |
| CA — SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) | $87 | $113 — $173 |
How to Reduce Your Cost for Pt re-eval est plan care
Practical tips that can save you hundreds or thousands of dollars
- 1 Ask about cash-pay discounts
Many hospitals and clinics offer 20-40% discounts for self-pay patients. Always ask before scheduling.
- 2 Compare facility vs. office setting costs
Some procedures cost significantly less in an office setting than a hospital. Ask your provider about options.
- 3 Shop around — costs vary significantly
Medicare rates for this procedure range from $63 to $87 depending on location. Commercial rates vary even more.
How is the Price Calculated?
Medicare calculates procedure payments using Relative Value Units (RVUs). Each procedure has three components multiplied by a conversion factor ($33.40 in 2026) and adjusted by geographic cost indices.
Payment = Total RVU (2.02) x CF ($33.40) = $67
Related Procedures
Similar procedures in the same category or body system
Frequently Asked Questions
How much does Pt re-eval est plan care cost?
The Medicare facility rate for Pt re-eval est plan care is $67. Commercial insurance rates typically range from 150% to 250% of Medicare (varies by plan).
How much does Pt re-eval est plan care cost without insurance?
Without insurance, the cost of Pt re-eval est plan care can range from 150% of Medicare to 500% of Medicare depending on the facility. Many hospitals and clinics offer self-pay discounts of 20-40% off their chargemaster price. Always ask about cash pricing before your visit.
Does insurance cover Pt re-eval est plan care?
Most commercial health insurance plans and Medicare cover Pt re-eval est plan care when ordered by a physician for a medically necessary reason. Your out-of-pocket cost depends on your plan's deductible, copay/coinsurance structure, and whether you use an in-network provider. Check with your insurance company before scheduling to confirm coverage and get a cost estimate.
Why does the cost vary so much by location?
Medicare adjusts payments using Geographic Practice Cost Indices (GPCIs) that reflect local differences in physician work costs, practice expenses, and malpractice insurance. Manhattan, San Francisco, and other high-cost areas pay significantly more than rural regions. Commercial insurers follow similar geographic patterns.