CPT code 97166: OT evaluation, moderate complexity2026 Medicare rate & RVUs in Nevada

In Nevada, Medicare pays $100.53 for 97166 in the office.

Check a contract rate as a % of Medicare · 97166 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 97166 covers

An occupational therapist evaluates how a health condition affects the patient’s daily activities, such as dressing, bathing, meal preparation, work, or home tasks. The evaluation may include an expanded occupational profile and review of medical or therapy history, assessment of functional performance, and clinical decision-making. Moderate complexity is supported by 3–5 performance deficits and a moderate level of analytic decision-making; comorbidities may affect performance, and evaluation may require minimal to moderate task modification or assistance. Common settings include outpatient therapy clinics, hospitals, and rehabilitation facilities.

Select this level from the documented history, deficits, decision-making, and assistance or task modification required—not from diagnosis alone. The note should support the occupational profile, relevant findings, evaluation complexity, and plan of care. The code represents one evaluation, with 45 minutes reflected in its descriptor; it is not billed in timed treatment increments. CMS treats it as a therapy service, so a professional-component modifier does not apply. Under the therapy multiple procedure payment reduction, the practice-expense portion is reduced for the 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 Nevada compares for 97166

Across 109 of 109 payment localities, the office rate for 97166 runs from $93.50 in Arkansas to $129.28 in Alaska. Nevada pays $100.53. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

97166 rates by state

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

See 97166 in every payment locality

How the 97166 rate is calculated

Each of 97166’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 97166

The CMS indicators that decide how 97166 is paid alongside other services.

What modifiers do to the payment

Codes related to 97166

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

How 97166 has changed in Nevada

Price 97166 for an earlier date of service

Where the Nevada rate applies

Nevada is a Medicare payment area, not a city. Our Census mapping connects it to 138 cities and communities in Nevada. Some span more than one payment area; confirm with the service ZIP.

• Alamo
• Amargosa Valley
• Austin
• Baker
• Battle Mountain
• Beatty
• Beaverdam
• Bennett Springs

Browse all communities in Nevada

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