CPT code 97165: OT evaluation, low complexity2026 Medicare rate & RVUs in Virginia

In Virginia, Medicare pays $99.61 for 97165 in the office.

Check a contract rate as a % of Medicare · 97165 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 97165 covers

An occupational therapist evaluates how a patient performs daily activities, such as dressing, bathing, cooking, or using the hands for work and self-care. The therapist gathers a focused occupational profile and relevant medical or therapy history, identifies performance problems, and determines whether skilled occupational therapy is appropriate. Evaluations commonly take place in outpatient clinics, rehabilitation settings, or other locations where occupational therapy is provided.

Choose this level when the evaluation involves low-complexity clinical decision making, a limited number of performance deficits, and few needed modifications to the assessment. Document the profile and history reviewed, functional findings, clinical reasoning, and resulting plan of care. The code identifies an evaluation service, not a unit selected by elapsed treatment time. Medicare treats it as a therapy service rather than separate professional and technical claims. When multiple therapy services are furnished on the same day, practice expense is reduced for the second and later therapy 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 Virginia compares for 97165

Across 109 of 109 payment localities, the office rate for 97165 runs from $93.50 in Arkansas to $129.28 in Alaska. Virginia pays $99.61. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

97165 rates by state

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

See 97165 in every payment locality

How the 97165 rate is calculated

Each of 97165’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 97165

The CMS indicators that decide how 97165 is paid alongside other services.

What modifiers do to the payment

Codes related to 97165

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

How 97165 has changed in Virginia

Price 97165 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