CMS October 2026Physician Fee Schedule · Free lookup

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%

CMS code description

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. 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 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.

See Medicaid rates for 97163

Commercial payers publish their negotiated rates for 97163 in transparency files. See how those compare with Medicare's rate.

Commercial rates for 97163

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Compare Medicare's rate for 97163 with published commercial rates

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Nearby codes

97116 Medicare rate 97140 Medicare rate 97150 Medicare rate 97161 Medicare rate 97162 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