CPT 97168 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 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

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	GO - Services delivered under an outpatient occupational therapy plan of care None 59 - Distinct Procedural Service
Complexity Level	Low
Medicare Fee Schedule	View Medicare rates for 97168

National average reimbursement for CPT 97168 by major payers:

$63.68

$62.21

$62.93

$77.84

Preview provider-level rates for...

For billing codeCPT 97168

Payer	Code	Rate	NPI	Tax ID	State	Specialty
United	97168	$42.00	1457505109 - WATTS PHYSICAL THERAPY PC	860554569 - (AZ) WATTS PHYSICAL THERAPY PC	AZ	Physical Therapist (225100000X)
United	97168	$168.19	1972734143 - MATTHEW VAIA	330106028 - (CA) SHARP REES-STEALY MEDICAL GROUP, INC.	AZ	Physical Therapist (225100000X)
United	97168	$42.34	1881675874 - GARY SMITH	752987075 - (AZ) GEORGE WANG, M.D., LLC	AZ	Physical Therapist (225100000X)
United	97168	$54.59	1508207549 - EMILY SCHUBBE	386004447 - (MI) CENTRAL MICHIGAN UNIVERSITY	AZ	Physical Therapist (225100000X)
United	97168	$64.23	1851522163 - LACEY FRANKLAND	363377698 - MIDWESTERN UNIVERSITY	AZ	Physical Therapist (225100000X)
United	97168	$64.23	1538632351 - ERICK MOON	260152289 - (AZ) ORTHOPEDIC SPECIALISTS OF NORTH AMERICA, PLLC	AZ	Physical Therapist (225100000X)
United	97168	$76.26	1659845857 - HILLAREE LEIF	460224743 - AVERA MCKENNAN	AZ	Physical Therapist (225100000X)
United	97168	$61.02	1609185727 - AMANDA HODGE	260152289 - (AZ) ORTHOPEDIC SPECIALISTS OF NORTH AMERICA, PLLC	AZ	Physical Therapist (225100000X)
United	97168	$64.23	1487170403 - LINDSAY CZAPLEWSKI	843032154 - (AZ) MODERN SPORTS MEDICINE LLC	AZ	Physical Therapist (225100000X)
United	97168	$40.88	1417011495 - BAYWOOD MEDICAL ASSOCIATES, PLLC	860505650 - (AZ) ANDRE C. MATTHEWS, M.D.	AZ	Physical Therapist (225100000X)
United	97168	$64.23	1124899422 - AUSTIN ALEXANDER	260152289 - (AZ) ORTHOPEDIC SPECIALISTS OF NORTH AMERICA, PLLC	AZ	Physical Therapist (225100000X)
United	97168	$61.02	1154755270 - S ANDERSON	260152289 - (AZ) ORTHOPEDIC SPECIALISTS OF NORTH AMERICA, PLLC	AZ	Physical Therapist (225100000X)
United	97168	$64.23	1205977014 - ANN DERRICK	880759614 - (AZ) RHAD HEALTH CARE LLC	AZ	Physical Therapist (225100000X)
United	97168	$90.11	1831543586 - CHELSEY ASIALA	901116753	AZ	Physical Therapist (225100000X)
United	97168	$133.00	1891076196 - STEPHANIE NGUYEN	911352172 - MULTICARE HEALTH SYSTEM	AZ	Physical Therapist (225100000X)
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 97168 vs. Other Physical Medicine and Rehabilitation Evaluations Codes

The CPT 97168 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 97168 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
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
97169-CPT	Low	Athletic Trn Eval Low Cmplx, Athletic Training Evaluation Low Complexity Requiring These Components A History And Physical Activity Profile With No Comorbidities That Affect Physical Activity An Examination Of Affected Body Area And Other Symptomatic Or Related Systems Addressing 1 2 Elements From Any Of The Following Body Structures Physical Activity And Or Participation Deficiencies And Clinical Decision Making Of Low Complexity Using Standardized Patient Assessment Instrument And Or Measurable Assessment Of Functional Outcome Typically 15 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 97168. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 97168 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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