CPT 97163 Medicare Fee Schedule 2026
Medicare's 2026 national payment for CPT 97163 is $97.87 in a non-facility setting ($97.87 in a facility), down 0.1% from $98.01 in 2025.
- Non-facility
- $97.87
- Facility
- $97.87
- vs. 2025
- -0.1%
- Commercial national avg.
- $95.77
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Run a free sample reportPt Eval High Complex 45 Min, Physical Therapy Evaluation High Complexity Requiring These Components A History Of Present Problem With 3 Or More Personal Factors And Or Comorbidities That Impact The Plan Of Care An Examination Of Body Systems Using Standardized Tests And Measures Addressing A Total Of 4 Or More Elements From Any Of The Following Body Structures And Functions Activity Limitations And Or Participation Restrictions A Clinical Presentation With Unstable And Unpredictable Characteristics And Clinical Decision Making Of High Complexity Using Standardized Patient Assessment Instrument And Or Measurable Assessment Of Functional Outcome Typically 45 Minutes Are Spent Face To Face With The Patient And Or Family
| Code | Date | State | Locality | Carrier | Non-Facility Fee | Facility Fee | Description |
|---|---|---|---|---|---|---|---|
| 97163 | 10/2026 | N/A | 00 | 00000 | $97.87 | $97.87 | Pt Eval High Complex 45 Min, Physical Therapy Evaluation High Complexity Requiring These Components A History Of Present Problem With 3 Or More Personal Factors And Or Comorbidities That Impact The Plan Of Care An Examination Of Body Systems Using Standardized Tests And Measures Addressing A Total Of 4 Or More Elements From Any Of The Following Body Structures And Functions Activity Limitations And Or Participation Restrictions A Clinical Presentation With Unstable And Unpredictable Characteristics And Clinical Decision Making Of High Complexity Using Standardized Patient Assessment Instrument And Or Measurable Assessment Of Functional Outcome Typically 45 Minutes Are Spent Face To Face With The Patient And Or Family |
| 97163 | 7/2026 | N/A | 00 | 00000 | $97.87 | $97.87 | Pt Eval High Complex 45 Min, Physical Therapy Evaluation High Complexity Requiring These Components A History Of Present Problem With 3 Or More Personal Factors And Or Comorbidities That Impact The Plan Of Care An Examination Of Body Systems Using Standardized Tests And Measures Addressing A Total Of 4 Or More Elements From Any Of The Following Body Structures And Functions Activity Limitations And Or Participation Restrictions A Clinical Presentation With Unstable And Unpredictable Characteristics And Clinical Decision Making Of High Complexity Using Standardized Patient Assessment Instrument And Or Measurable Assessment Of Functional Outcome Typically 45 Minutes Are Spent Face To Face With The Patient And Or Family |
| 97163 | 4/2026 | N/A | 00 | 00000 | $97.87 | $97.87 | Pt Eval High Complex 45 Min, Physical Therapy Evaluation High Complexity Requiring These Components A History Of Present Problem With 3 Or More Personal Factors And Or Comorbidities That Impact The Plan Of Care An Examination Of Body Systems Using Standardized Tests And Measures Addressing A Total Of 4 Or More Elements From Any Of The Following Body Structures And Functions Activity Limitations And Or Participation Restrictions A Clinical Presentation With Unstable And Unpredictable Characteristics And Clinical Decision Making Of High Complexity Using Standardized Patient Assessment Instrument And Or Measurable Assessment Of Functional Outcome Typically 45 Minutes Are Spent Face To Face With The Patient And Or Family |
| 97163 | 1/2026 | N/A | 00 | 00000 | $97.87 | $97.87 | Pt Eval High Complex 45 Min, Physical Therapy Evaluation High Complexity Requiring These Components A History Of Present Problem With 3 Or More Personal Factors And Or Comorbidities That Impact The Plan Of Care An Examination Of Body Systems Using Standardized Tests And Measures Addressing A Total Of 4 Or More Elements From Any Of The Following Body Structures And Functions Activity Limitations And Or Participation Restrictions A Clinical Presentation With Unstable And Unpredictable Characteristics And Clinical Decision Making Of High Complexity Using Standardized Patient Assessment Instrument And Or Measurable Assessment Of Functional Outcome Typically 45 Minutes Are Spent Face To Face With The Patient And Or Family |
| 97163 | 10/2025 | N/A | 00 | 00000 | $98.01 | $98.01 | Pt Eval High Complex 45 Min, Physical Therapy Evaluation High Complexity Requiring These Components A History Of Present Problem With 3 Or More Personal Factors And Or Comorbidities That Impact The Plan Of Care An Examination Of Body Systems Using Standardized Tests And Measures Addressing A Total Of 4 Or More Elements From Any Of The Following Body Structures And Functions Activity Limitations And Or Participation Restrictions A Clinical Presentation With Unstable And Unpredictable Characteristics And Clinical Decision Making Of High Complexity Using Standardized Patient Assessment Instrument And Or Measurable Assessment Of Functional Outcome Typically 45 Minutes Are Spent Face To Face With The Patient And Or Family |
| 97163 | 7/2025 | N/A | 00 | 00000 | $98.01 | $98.01 | Pt Eval High Complex 45 Min, Physical Therapy Evaluation High Complexity Requiring These Components A History Of Present Problem With 3 Or More Personal Factors And Or Comorbidities That Impact The Plan Of Care An Examination Of Body Systems Using Standardized Tests And Measures Addressing A Total Of 4 Or More Elements From Any Of The Following Body Structures And Functions Activity Limitations And Or Participation Restrictions A Clinical Presentation With Unstable And Unpredictable Characteristics And Clinical Decision Making Of High Complexity Using Standardized Patient Assessment Instrument And Or Measurable Assessment Of Functional Outcome Typically 45 Minutes Are Spent Face To Face With The Patient And Or Family |
| 97163 | 4/2025 | N/A | 00 | 00000 | $98.01 | $98.01 | Pt Eval High Complex 45 Min, Physical Therapy Evaluation High Complexity Requiring These Components A History Of Present Problem With 3 Or More Personal Factors And Or Comorbidities That Impact The Plan Of Care An Examination Of Body Systems Using Standardized Tests And Measures Addressing A Total Of 4 Or More Elements From Any Of The Following Body Structures And Functions Activity Limitations And Or Participation Restrictions A Clinical Presentation With Unstable And Unpredictable Characteristics And Clinical Decision Making Of High Complexity Using Standardized Patient Assessment Instrument And Or Measurable Assessment Of Functional Outcome Typically 45 Minutes Are Spent Face To Face With The Patient And Or Family |
| 97163 | 1/2025 | N/A | 00 | 00000 | $98.01 | $98.01 | Pt Eval High Complex 45 Min, Physical Therapy Evaluation High Complexity Requiring These Components A History Of Present Problem With 3 Or More Personal Factors And Or Comorbidities That Impact The Plan Of Care An Examination Of Body Systems Using Standardized Tests And Measures Addressing A Total Of 4 Or More Elements From Any Of The Following Body Structures And Functions Activity Limitations And Or Participation Restrictions A Clinical Presentation With Unstable And Unpredictable Characteristics And Clinical Decision Making Of High Complexity Using Standardized Patient Assessment Instrument And Or Measurable Assessment Of Functional Outcome Typically 45 Minutes Are Spent Face To Face With The Patient And Or Family |
97163 national rate by year
Each row is the latest CMS file published that year. Change is against the year before.
| CMS file | Non-facility | Facility | Change |
|---|---|---|---|
| October 2026 | $97.87 | $97.87 | -0.1% |
| October 2025 | $98.01 | $98.01 | -2.2% |
| March 2024 | $100.20 | $100.20 | -1.4% |
| January 2023 | $101.66 | $101.66 | -0.8% |
| July 2022 | $102.43 | $102.43 | - |
This is the national amount before geographic adjustment. Medicare multiplies each relative value unit by its locality's geographic practice cost index, so a practice's own allowed amount can be higher or lower; pick a state above to see its localities. The facility amount applies when the service is performed in a hospital or other facility setting.
97163: Medicare vs. commercial national average
The commercial national average for 97163, the mean of what BCBS, UnitedHealthcare, Aetna and Cigna publish nationwide, is $95.77, 98% of Medicare's $97.87.
- BCBS $93.46
- UnitedHealthcare $89.93
- Aetna $90.85
- Cigna $108.85
A national average, not a local rate: each payer's figure averages the unmodified, in-network professional rates it publishes for 97163 across the country in its transparency files. Contracted rates vary widely by market, provider and plan. Medicare's figure is its national non-facility amount before geographic adjustment.
Nearby codes
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See what state Medicaid programs pay for 97163
50 state Medicaid agencies publish their own physician fee schedule. The 97163 page shows real published rates for several of them free, with effective dates and official sources.
17,674 codes and 974,327 published rates, taken from the files the state agencies publish themselves.
Related codes
Methodology
Rates are sourced directly from CMS Physician Fee Schedule files, indexed quarterly. Non-facility and facility prices are calculated using the published GPCI for each locality and the year's conversion factor.
View CMS Physician Fee Schedule