CPT 97162 Fee Schedule

Last Verified: July 2026

Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.

Pt Eval Mod Complex 30 Min, Physical Therapy Evaluation Moderate Complexity Requiring These Components A History Of Present Problem With 1 2 Personal Factors And Or Comorbidities That Impact The Plan Of Care An Examination Of Body Systems Using Standardized Tests And Measures In Addressing A Total Of 3 Or More Elements From Any Of The Following Body Structures And Functions Activity Limitations And Or Participation Restrictions An Evolving Clinical Presentation With Changing Characteristics And Clinical Decision Making Of Moderate Complexity Using Standardized Patient Assessment Instrument And Or Measurable Assessment Of Functional Outcome Typically 30 Minutes Are Spent Face To Face With The Patient And Or Family

Key Fact	Detail
Service Type	Physical Medicine and Rehabilitation Therapeutic Procedures Physical Medicine and Rehabilitation Evaluations
Common Place of Service	11 - Office None
Common Modifiers	None GP - Services delivered under an outpatient physical therapy plan of care KX - Requirements specified in the medical policy have been met
Complexity Level	Low
Medicare Fee Schedule	View Medicare rates for 97162

National average reimbursement for CPT 97162 by major payers:

$92.81

$89.93

$91.35

$108.82

Preview provider-level rates for...

For billing codeCPT 97162

Payer	Code	Rate	NPI	Tax ID	State	Specialty
United	97162	$76.30	1225211600 - JOHN MILLICHAP	731310891 - WARREN CLINIC INC	NC	Neurology with Special Qualifications in Child Neurology Physician (2084N0402X)
United	97162	$122.30	1962767376 - AMAN DEEP SINGH	770460802	IL	Psychiatry Physician (2084P0800X)
United	97162	$328.17	1043656937 - MONICA SINHA-EVENSON	770465765	CA	Psychiatry Physician (2084P0800X)
United	97162	$118.51	1255478004 - CHRISTOPHER RAIO	208243412 - SAMARITAN EMERGENCY MEDICAL SERVICES PC	NY	Emergency Medicine Physician (207P00000X)
United	97162	$109.26	1730158460 - RODNEY DEGUZMAN	743104659 - ANCHOR FAMILY MEDICAL GROUP	CA	Family Medicine Physician (207Q00000X)
United	97162	$77.61	1053669390 - BRENDA SHEN	330283773 - PROVIDENCE MEDICAL INSTITUTE	CA	Family Medicine Physician (207Q00000X)
United	97162	$73.14	1982894606 - ARBI OHANIAN	273759386 - SOUTHERN CALIFORNIA NEUROLOGY MEDICAL GROUP, INC.	CA	Neurology Physician (2084N0400X)
United	97162	$137.30	1871196477 - TAYLOR WILLIAMS	362691111 - ROCKFORD ORTHOPEDIC ASSOCIATES, LTD.	CA	Physician Assistant (363A00000X)
United	97162	$87.70	1013430982 - FAMILY WELLNESS CLINIC, INC	822214663 - FAMILY WELLNESS CLINIC INC	CA	Internal Medicine Physician (207R00000X)
United	97162	$109.26	1063446953 - RICARDO MOLINA	943248795 - MISSION PEAK ORTHOPAEDIC MEDICAL GROUP, INC.	CA	Orthopaedic Surgery Physician (207X00000X)
United	97162	$61.56	1942686142 - DAVID PICELLA PHD INC	454084136 - DAVID PICELLA PHD INC	CA	Nurse Practitioner (363L00000X)
United	97162	$224.08	1295155109 - PANTEHA REZAEIAN	954457756 - CEDARS-SINAI MEDICAL CARE FOUNDATION	CA	Family Medicine Physician (207Q00000X)
United	97162	$92.80	1770511081 - AMY LIN	680357690 - ADVENTIST HEALTH PHYSICANS NETWORK	CA	Family Medicine Physician (207Q00000X)
United	97162	$87.70	1265183594 - FIRST PEDIATRICS HANFORD	871852412 - FIRST PEDIATRICS HANFORD	CA	Pediatric Adolescent Medicine Physician (2080A0000X)
United	97162	$358.53	1154479723 - THE REGENTS OF THE UNIVERSITY OF CALIFORNIA-IRVINE	208148732	CA	Hospitalist Physician (208M00000X)
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist

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CPT 97162 vs. Other Physical Medicine and Rehabilitation Evaluations Codes

The CPT 97162 code is part of the Physical Medicine and Rehabilitation Therapeutic Procedures services used for Physical Medicine and Rehabilitation Evaluations. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.

The CPT 97162 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.

Code	Complexity	Description
97161-CPT	Low	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
97162-CPT	Low	Pt Eval Mod Complex 30 Min, Physical Therapy Evaluation Moderate Complexity Requiring These Components A History Of Present Problem With 1 2 Personal Factors And Or Comorbidities That Impact The Plan Of Care An Examination Of Body Systems Using Standardized Tests And Measures In Addressing A Total Of 3 Or More Elements From Any Of The Following Body Structures And Functions Activity Limitations And Or Participation Restrictions An Evolving Clinical Presentation With Changing Characteristics And Clinical Decision Making Of Moderate Complexity Using Standardized Patient Assessment Instrument And Or Measurable Assessment Of Functional Outcome Typically 30 Minutes Are Spent Face To Face With The Patient And Or Family
97163-CPT	Low	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

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 97162. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 97162 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.

Factors that affect fee schedules

Medicare & Medicaid Rates

Government-set reimbursement amounts

Private Insurance Rates

Negotiated rates between providers and insurance companies

Geographic Location

Costs may be higher in urban areas.

Provider Type

Hospital providers may have different rates than private practice.

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