CPT code 97161: PT evaluation, low complexity, typically 20 minutes2026 Medicare rate & RVUs in Idaho

In Idaho, Medicare pays $94.00 for 97161 in the office.

Check a contract rate as a % of Medicare · 97161 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 97161 covers

A physical therapist uses this initial evaluation to assess movement, functional limitations, and rehabilitation needs in private practice, an outpatient clinic, or a hospital outpatient department. Low complexity calls for a history without personal factors or comorbidities affecting the plan, examination of one or two elements, a stable presentation, and low-complexity clinical decision making supported by standardized assessment tools or measurable functional outcomes. An adult with a straightforward musculoskeletal complaint may fit when the documented findings meet these criteria. The therapist uses the findings to establish functional goals and a treatment plan.

Report one unit for the evaluation; approximately 20 minutes face to face is typical, not a billing threshold. Select the level from the documented history, examined elements, presentation, and decision making rather than time or one component alone. Record the findings, assessment measures, goals, and plan of care for physician or nonphysician practitioner certification. Medicare physical therapy claims use modifier GP. This therapy service is billed without separate professional and technical components, so modifier 26 is inappropriate. When multiple therapy units are billed on the same day, the therapy multiple procedure payment reduction reduces practice expense for the second and later units.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

How Idaho compares for 97161

Across 109 of 109 payment localities, the office rate for 97161 runs from $91.20 in Arkansas to $126.43 in Alaska. Idaho pays $94.00. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

97161 rates by state

Office rate range in each state. Select a state to see its payment localities.

See 97161 in every payment locality

How the 97161 rate is calculated

Each of 97161’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 97161

The CMS indicators that decide how 97161 is paid alongside other services.

What modifiers do to the payment

Codes related to 97161

Related codes aren’t interchangeable: bill the code that matches the service performed.

How 97161 has changed in Idaho

Price 97161 for an earlier date of service

Where the Idaho rate applies

Idaho is a Medicare payment area, not a city. Our Census mapping connects it to 235 cities and communities in Idaho. Some span more than one payment area; confirm with the service ZIP.

• Aberdeen
• Acequia
• Albion
• American Falls
• Ammon
• Arbon Valley
• Arco
• Arimo

Browse all communities in Idaho

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates