CPT code 97162: PT evaluation, moderate complexity2026 Medicare rate & RVUs in Virginia

In Virginia, Medicare pays $96.98 for 97162 in the office.

Check a contract rate as a % of Medicare · 97162 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 97162 covers

A physical therapist performs this evaluation at the start of a treatment episode, often in a private practice or outpatient clinic. Referrals after a fall, joint replacement, or lumbar strain do not alone establish complexity. The moderate level requires one or two personal factors or comorbidities affecting the plan, examination of at least three elements of body structures and functions, activity limitations, or participation restrictions, an evolving presentation, and moderate clinical decision making supported by a standardized assessment or measurable functional outcome. Face-to-face time is typically about 30 minutes.

Report 97162 once per evaluation, not in 15-minute units; typical time is not a billing threshold. Document how the history, examination, presentation, and decision making support moderate complexity, including relevant comorbidities, findings, outcome measures, goals, and the plan of care. Medicare physical therapy claims use the GP modifier; the professional component modifier 26 is not used for this therapy service. Under Medicare’s therapy multiple procedure payment reduction, the therapy unit with the highest practice expense receives unreduced practice expense; practice expense is reduced for second and later therapy units on the same day.

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 Virginia compares for 97162

Across 109 of 109 payment localities, the office rate for 97162 runs from $91.20 in Arkansas to $126.43 in Alaska. Virginia pays $96.98. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

97162 rates by state

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

See 97162 in every payment locality

How the 97162 rate is calculated

Each of 97162’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 97162

The CMS indicators that decide how 97162 is paid alongside other services.

What modifiers do to the payment

Codes related to 97162

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

How 97162 has changed in Virginia

Price 97162 for an earlier date of service

Where the Virginia rate applies

Virginia is a Medicare payment area, not a city. Our Census mapping connects it to 628 cities and communities in Virginia. Some span more than one payment area; confirm with the service ZIP.

• Abbs Valley
• Abingdon
• Accomac
• Adwolf
• Afton
• Alberta
• Aldie
• Allison Gap

Browse all communities in Virginia

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