Medicare Fee Schedule Lookup
Find 2026 Medicare reimbursement rates and national payment amounts for any CPT, HCPCS, or MS-DRG code. Physician Fee Schedule, Drug ASP, MS-DRG weights, Anesthesia, and Clinical Lab — sourced directly from CMS.
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Run a free sample reportOt Eval High Complex 60 Min, Occupational Therapy Evaluation High Complexity Requiring These Components An Occupational Profile And Medical And Therapy History Which Includes Review Of Medical And Or Therapy Records And Extensive Additional Review Of Physical Cognitive Or Psychosocial History Related To Current Functional Performance An Assessment S That Identifies 5 Or More Performance Deficits Ie Relating To Physical Cognitive Or Psychosocial Skills That Result In Activity Limitations And Or Participation Restrictions And Clinical Decision Making Of High Analytic Complexity Which Includes An Analysis Of The Patient Profile Analysis Of Data From Comprehensive Assessment S And Consideration Of Multiple Treatment Options Patient Presents With Comorbidities That Affect Occupational Performance Significant Modification Of Tasks Or Assistance Eg Physical Or Verbal With Assessment S Is Necessary To Enable Patient To Complete Evaluation Component Typically 60 Minutes Are Spent Face To Face With The Patient And Or Family
| Code | Date | State | Locality | Carrier | Non-Facility Fee | Facility Fee | Description |
|---|---|---|---|---|---|---|---|
| 97167 | 7/2026 | N/A | 00 | 00000 | $100.54 | $100.77 | Ot Eval High Complex 60 Min, Occupational Therapy Evaluation High Complexity Requiring These Components An Occupational Profile And Medical And Therapy History Which Includes Review Of Medical And Or Therapy Records And Extensive Additional Review Of Physical Cognitive Or Psychosocial History Related To Current Functional Performance An Assessment S That Identifies 5 Or More Performance Deficits Ie Relating To Physical Cognitive Or Psychosocial Skills That Result In Activity Limitations And Or Participation Restrictions And Clinical Decision Making Of High Analytic Complexity Which Includes An Analysis Of The Patient Profile Analysis Of Data From Comprehensive Assessment S And Consideration Of Multiple Treatment Options Patient Presents With Comorbidities That Affect Occupational Performance Significant Modification Of Tasks Or Assistance Eg Physical Or Verbal With Assessment S Is Necessary To Enable Patient To Complete Evaluation Component Typically 60 Minutes Are Spent Face To Face With The Patient And Or Family |
| 97167 | 4/2026 | N/A | 00 | 00000 | $100.54 | $100.77 | Ot Eval High Complex 60 Min, Occupational Therapy Evaluation High Complexity Requiring These Components An Occupational Profile And Medical And Therapy History Which Includes Review Of Medical And Or Therapy Records And Extensive Additional Review Of Physical Cognitive Or Psychosocial History Related To Current Functional Performance An Assessment S That Identifies 5 Or More Performance Deficits Ie Relating To Physical Cognitive Or Psychosocial Skills That Result In Activity Limitations And Or Participation Restrictions And Clinical Decision Making Of High Analytic Complexity Which Includes An Analysis Of The Patient Profile Analysis Of Data From Comprehensive Assessment S And Consideration Of Multiple Treatment Options Patient Presents With Comorbidities That Affect Occupational Performance Significant Modification Of Tasks Or Assistance Eg Physical Or Verbal With Assessment S Is Necessary To Enable Patient To Complete Evaluation Component Typically 60 Minutes Are Spent Face To Face With The Patient And Or Family |
| 97167 | 1/2026 | N/A | 00 | 00000 | $100.54 | $100.77 | Ot Eval High Complex 60 Min, Occupational Therapy Evaluation High Complexity Requiring These Components An Occupational Profile And Medical And Therapy History Which Includes Review Of Medical And Or Therapy Records And Extensive Additional Review Of Physical Cognitive Or Psychosocial History Related To Current Functional Performance An Assessment S That Identifies 5 Or More Performance Deficits Ie Relating To Physical Cognitive Or Psychosocial Skills That Result In Activity Limitations And Or Participation Restrictions And Clinical Decision Making Of High Analytic Complexity Which Includes An Analysis Of The Patient Profile Analysis Of Data From Comprehensive Assessment S And Consideration Of Multiple Treatment Options Patient Presents With Comorbidities That Affect Occupational Performance Significant Modification Of Tasks Or Assistance Eg Physical Or Verbal With Assessment S Is Necessary To Enable Patient To Complete Evaluation Component Typically 60 Minutes Are Spent Face To Face With The Patient And Or Family |
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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.
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