CMS October 2026Physician Fee Schedule · Free lookup

CPT 97161 Medicare Fee Schedule 2026

Medicare's 2026 national payment for CPT 97161 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%

CMS code description

Pt Eval Low Complex 20 Min, Physical Therapy Evaluation Low Complexity Requiring These Components A History With No Personal Factors And Or Comorbidities That Impact The Plan Of Care An Examination Of Body System S Using Standardized Tests And Measures Addressing 1 2 Elements From Any Of The Following Body Structures And Functions Activity Limitations And Or Participation Restrictions A Clinical Presentation With Stable And Or Uncomplicated Characteristics And Clinical Decision Making Of Low Complexity Using Standardized Patient Assessment Instrument And Or Measurable Assessment Of Functional Outcome Typically 20 Minutes Are Spent Face To Face With The Patient And Or Family

97161 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. The facility amount applies when the service is performed in a hospital or other facility setting.

Medicaid comparison

See what state Medicaid programs pay for 97161

50 state Medicaid agencies publish their own physician fee schedule. The 97161 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.

See Medicaid rates for 97161

Commercial payers publish their negotiated rates for 97161 in transparency files. See how those compare with Medicare's rate.

Commercial rates for 97161

PayerPrice Platform

Compare Medicare's rate for 97161 with published commercial rates

Search negotiated rates from more than 180 commercial payers by NPI, TIN, and ZIP code. Review historical rates or export the data through API, SQL, MCP, or bulk download.

Schedule a demo Run a free sample report

Nearby codes

97116 Medicare rate 97140 Medicare rate 97150 Medicare rate 97162 Medicare rate 97163 Medicare rate 97164 Medicare rate

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