CPT 97167 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.

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

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 GO - Services delivered under an outpatient occupational therapy plan of care KX - Requirements specified in the medical policy have been met
Complexity Level	Low
Medicare Fee Schedule	View Medicare rates for 97167

National average reimbursement for CPT 97167 by major payers:

$94.35

$91.76

$92.24

$109.88

Preview provider-level rates for...

For billing codeCPT 97167

Payer	Code	Rate	NPI	Tax ID	State	Specialty
United	97167	$35.00	1700494481 - GISELLE AQUINO	872614339	FL	Speech-Language Pathologist (235Z00000X)
United	97167	$87.83	1306340880 - GEORGE GIANAKAKOS	364015560 - LOYOLA UNIVERSITY MEDICAL CENTER	FL	Psychiatry Physician (2084P0800X)
United	97167	$56.95	1164568119 - THOMAS LOLAN	455531481 - (OH) SOUTH DAYTON HEARING AIDS AUDIOLOGY LLC	OH	Audiologist-Hearing Aid Fitter (237600000X)
United	97167	$74.77	1861058158 - JENNIFER SCHELLING	351298203 - (IN) HAND SURGERY ASSOCIATES OF INDIANA, INC.	IN	Occupational Therapist (225X00000X)
United	97167	$215.00	1942530019 - MALEAH CUMMINGS	382908586 - ASPIRUS IRONWOOD HOSPITAL & CLINICS INC	MI	Clinical Psychologist (103TC0700X)
United	97167	$78.83	1548375058 - OLANIYI OSUNTOKUN	871090569 - (TX) GUIDESTAR ELDERCARE NEUROPSYCHIATRIC GROUP	IN	Psychiatry Physician (2084P0800X)
United	97167	$92.75	1881012235 - LAUREN PREST	910843135	UT	Psychiatry Physician (2084P0800X)
United	97167	$71.97	1043606742 - JENIFER LLOYD	376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS	IL	Psychiatry Physician (2084P0800X)
United	97167	$173.75	1790181402 - SONAM VERMA	364143823 - SIU PHYSICIANS & SURGEONS INC	IL	Neurology with Special Qualifications in Child Neurology Physician (2084N0402X)
United	97167	$77.47	1205975448 - CHRISTOPHER JOHNSON	371158318 - (IL) SOUTHERN ILLINOIS HEALTHCARE FOUNDATION INC	IL	Psychiatry Physician (2084P0800X)
United	97167	$78.83	1952966566 - THOMAS CALL	741895428 - (TX) SAN ANTONIO HEAD NECK SURGICAL ASSOCIATES PA	TX	Audiologist (231H00000X)
United	97167	$96.62	1205831393 - PRITI SINGH	461302245 - (IL) ASSOCIATES IN PEDIATRIC NEUROLOGY SC	IL	Neurology with Special Qualifications in Child Neurology Physician (2084N0402X)
United	97167	$80.08	1730263617 - MARK ALTER	811324691	NJ	Child & Adolescent Psychiatry Physician (2084P0804X)
United	97167	$92.75	1942461231 - ANUPAMA WADHWA	756002868	IL	Child & Adolescent Psychiatry Physician (2084P0804X)
United	97167	$105.50	1194476846 - MACKENZIE MATTINGLY	208877982 - (TN) ADVANCED THERAPY SOLUTIONS	NC	Clinical Social Worker (1041C0700X)
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 97167 vs. Other Physical Medicine and Rehabilitation Evaluations Codes

The CPT 97167 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 97167 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
97166-CPT	Low	Ot Eval Mod Complex 45 Min, Occupational Therapy Evaluation Moderate Complexity Requiring These Components An Occupational Profile And Medical And Therapy History Which Includes An Expanded Review Of Medical And Or Therapy Records And Additional Review Of Physical Cognitive Or Psychosocial History Related To Current Functional Performance An Assessment S That Identifies 3 5 Performance Deficits Ie Relating To Physical Cognitive Or Psychosocial Skills That Result In Activity Limitations And Or Participation Restrictions And Clinical Decision Making Of Moderate Analytic Complexity Which Includes An Analysis Of The Occupational Profile Analysis Of Data From Detailed Assessment S And Consideration Of Several Treatment Options Patient May Present With Comorbidities That Affect Occupational Performance Minimal To Moderate Modification Of Tasks Or Assistance Eg Physical Or Verbal With Assessment S Is Necessary To Enable Patient To Complete Evaluation Component Typically 45 Minutes Are Spent Face To Face With The Patient And Or Family
97167-CPT	Low	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
97168-CPT	Low	Ot Re Eval Est Plan Care, Re Evaluation Of Occupational Therapy Established Plan Of Care Requiring These Components An Assessment Of Changes In Patient Functional Or Medical Status With Revised Plan Of Care An Update To The Initial Occupational Profile To Reflect Changes In Condition Or Environment That Affect Future Interventions And Or Goals And A Revised Plan Of Care A Formal Reevaluation Is Performed When There Is A Documented Change In Functional Status Or A Significant Change To The Plan Of Care Is Required Typically 30 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 97167. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 97167 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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