CPT 2026 · Physical Medicine

CPT 97172

Global XXX

Athletic trn re-eval plan cr

Effective 2026-04-01 Conv. factor $33.4009

No national RVU

Payment Methodology

Status Indicator

NCCI Partners

XXX

Global Period

No national RVU

This code does not have a national work RVU on the current Physician Fee Schedule. Pricing may be carrier-determined, non-covered, or tracked via a separate methodology.

CPT 97172 Billing & Documentation Guide

CPT code 97172 (Athletic trn re-eval plan cr) is classified under Physical Medicine with a global period indicator of XXX. This code uses the No national RVU payment methodology rather than standard RVU-based Physician Fee Schedule pricing. Refer to the methodology notice above for billing implications.

When billing 97172, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 97172 with related codes; this code has 10 PTP bundling relationships on file (see table below).

Payment Status & Global Period

CMS Status Indicator

Non-covered service

Global Period

XXX

No global period (E/M and other non-procedural services)

MUE Limit (Medically Unlikely Edits)

Max units per beneficiary per date of service

Rationale: CMS Policy

Adjudication: Date of Service (Clinical)

Source: CMS NCCI MUE Practitioner Services, effective 2026-04-01.

Submitting more than 0 units of 97172 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.

NCCI Bundling Edits, CPT 97172

Procedure-to-procedure (PTP) edits. If you bill any of these codes with 97172 on the same date of service, review the modifier indicator and payer policy before submission.

Partner Code	Relationship	Modifier Allowed	Rationale
36591	Column 1 (primary), can be billed with modifier	No	CPT Manual or CMS manual coding instruction
36592	Column 1 (primary), can be billed with modifier	No	CPT Manual or CMS manual coding instruction
95851	Column 1 (primary), can be billed with modifier	No	CPT Separate procedure definition
95852	Column 1 (primary), can be billed with modifier	No	CPT Separate procedure definition
96523	Column 1 (primary), can be billed with modifier	No	CPT Manual or CMS manual coding instruction
97140	Column 1 (primary), can be billed with modifier	Yes	Standards of medical/surgical practice
0591T	Column 2 (secondary), bundled into primary	Yes	Standards of medical/surgical practice
0592T	Column 2 (secondary), bundled into primary	Yes	Standards of medical/surgical practice
0593T	Column 2 (secondary), bundled into primary	Yes	Standards of medical/surgical practice
96020	Column 2 (secondary), bundled into primary	Yes	Misuse of Column Two code with Column One code

Frequently Asked Questions, CPT 97172

What does CPT code 97172 mean? +

CPT code 97172 represents: Athletic trn re-eval plan cr. It's in the Physical Medicine category with a global period of XXX.

What is the Medicare reimbursement for CPT 97172? +

This code does not have a national work RVU on the current Physician Fee Schedule. Pricing may be carrier-determined, non-covered, or tracked via a separate methodology.

What modifiers can I use with CPT 97172? +

Medicine section spans a wide range: therapy services use GP/GO/GN (PT/OT/SLP plans of care) and KX (above cap with documentation). Drug administration uses JW (waste) and JZ (no waste). Professional/technical split applies to some diagnostic codes.

What bundling edits apply to CPT 97172? +

This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.