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CPT code 97168: OT reevaluation, established plan of care2026 Medicare rate & RVUs

Occupational therapists report 97168 when reassessing an established plan of care after functional or medical changes warrant renewed analysis and plan revision.

CMS RVU26DEffective Oct 1, 2026109 payment localities41.1K Medicare services in 2024

Medicare pays $68.47 for 97168 nationally in the office. Local office rates run $63.22–$87.79.

Medicare rate · 97168

OT reevaluation, established plan of care

Office or facility?

Work RVUs
0.96
Total RVUs
2.05
Global days
XXX

National rate · 2026

$68.47

Office setting, before claim adjustments.

See every locality for 97168 →Billed by an NP, PA or therapist? →

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

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 97168 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 97168 covers

An occupational therapist reassesses a patient who already has an established plan of care when a change in function or medical status calls for renewed clinical analysis. The therapist may review the patient’s occupational and medical history, assess current performance in daily activities, and determine whether goals or interventions need revision. This service is distinct from routine treatment progress and from an initial occupational therapy evaluation that establishes the plan.

Report one reevaluation when the reassessment supports a revised plan of care; document the change prompting reassessment, findings, clinical reasoning, and any updated goals or interventions. It is a therapy service, not a separately billed professional component, so a professional-component modifier does not apply. When multiple therapy units are furnished on the same day, CMS reduces the 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.

Where 97168 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 payment localities

$63.22 to $87.79

$63.22$75.50$87.79
One dot per payment locality, office / nonfacility. Hover a dot to see the locality; select it to open that rate.

109 of 109 payment localities

97168 office and facility rates by payment locality
Payment localityOfficeFacility
Alabama$63.82Unavailable
Alaska$86.70Unavailable
Arizona$67.31Unavailable
Arkansas$63.22Unavailable
Atlanta, GA$69.21Unavailable
Austin, TX$70.59Unavailable
Bakersfield, CA$72.41Unavailable
Baltimore area, MD$71.70Unavailable
Beaumont, TX$65.20Unavailable
Brazoria, TX$68.33Unavailable

97168 rates by state

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

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Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$63.22

$86.70

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
97168 office rate range by state
State / territoryOffice rate rangeLocalities
AK$86.701
AL$63.821
AR$63.221
AZ$67.311
CA$72.32–$87.7929
CO$71.091
CT$71.961
DC$76.661
DE$68.171
FL$67.05–$70.463
GA$64.64–$69.212
GU$73.271
HI$73.271
IA$65.201
ID$65.411
IL$65.52–$69.934
IN$65.671
KS$64.841
KY$64.441
LA$64.31–$66.392
MA$70.83–$76.752
MD$69.20–$76.663
ME$65.46–$68.022
MI$65.38–$67.442
MN$69.281
MO$63.49–$66.743
MS$63.371
MT$68.471
NC$65.931
ND$68.271
NE$65.491
NH$69.911
NJ$73.11–$76.292
NM$65.541
NV$68.451
NY$66.57–$77.635
OH$65.341
OK$64.541
OR$68.23–$72.902
PA$65.50–$70.592
PR$68.861
RI$70.241
SC$65.681
SD$68.251
TN$65.031
TX$65.20–$70.598
UT$66.271
VA$67.76–$76.662
VI$68.861
VT$67.951
WA$70.72–$78.202
WI$66.731
WV$63.891
WY$68.391

How the 97168 rate is calculated

Each of 97168’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.

How the rate is built · 97168

RVUs × geographic indexes × conversion factor

Office or facility?

Work0.96

0.96 RVUs× 1.000 GPCI

Practice expense1.08

1.08 RVUs× 1.000 GPCI

Malpractice0.01

0.01 RVUs× 1.000 GPCI

Adjusted RVUs

2.0500

Conversion factor

$33.4009

Medicare rate

$68.47

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 97168

The CMS indicators that decide how 97168 is paid alongside other services.

CMS payment indicators · 97168

OT reevaluation, established plan of care

RuleCMS valueWhat it means
Global periodXXXThe global surgery concept doesn’t apply.
Multiple procedures5Therapy reduction: practice expense of the second and later units is reduced.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical7Therapy service: the split doesn’t apply.

What modifiers do to the payment

Modifier CQ · payment effect

With and without the modifier

97168 without CQ · national office

$68.47

OT reevaluation, established plan of care

97168-CQ · Allowed amount unchanged

$68.47

Medicare cuts its own payment by 15% after the patient’s 20% coinsurance; the allowed amount stays the same. On $100 allowed: $20 coinsurance, then Medicare pays $68 instead of $80.

97168 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 97168

    OT reevaluation, established plan of care0.96 wRVU

    $68.47

  • 97164

    PT re-evaluation, established plan of care0.96 wRVU

    $67.47−$1.00

  • 97165

    OT evaluation, low complexity1.54 wRVU

    $100.54+$32.07

  • 97167

    OT evaluation, high complexity1.54 wRVU

    $100.54+$32.07

How to choose

97164PT re-evaluationEstablished plan of care
97164 is for physical therapy reevaluation of an established plan. Use 97168 for occupational therapy reevaluation.
97165OT evaluationLow complexity
97165 is an initial OT evaluation at low complexity. Choose 97168 when an established plan is being reassessed after a change in status.
97167OT evaluationHigh complexity
97167 is an initial OT evaluation at high complexity. Its complexity level does not make it a substitute for reevaluation of an established plan.

Codes related to 97168

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

Codes related to 97168
CodeHow it relatesNational office range
Used instead
97164PT re-evaluation, established plan of carePhysical therapy reevaluation for an established plan rather than occupational therapy reevaluation.$62.36–$86.34
Same family
97165OT evaluation, low complexityInitial OT evaluation at the low-complexity level, rather than reevaluation.$93.50–$129.28
97166OT evaluation, moderate complexityInitial OT evaluation at the moderate-complexity level, rather than reevaluation.$93.50–$129.28
97167OT evaluation, high complexityInitial OT evaluation at the high-complexity level, rather than reevaluation.$93.50–$129.28
Often billed with
97140Manual therapy, one or more regions, each 15 minutesManual therapy may be separately reported when distinct treatment is furnished during the same visit.$25.72–$35.60

97168 billing questions

When should 97168 be chosen instead of an initial OT evaluation?

Use 97168 when the patient already has an established occupational therapy plan and a change in status prompts a reassessment and possible plan revision. Use an initial OT evaluation when establishing the plan of care.

How is 97168 different from physical therapy reevaluation 97164?

Both describe reevaluation of an established plan, but 97168 is for occupational therapy and 97164 is for physical therapy.

Can 97168 be reported with treatment on the same day?

A separately furnished therapy treatment may be reported when it is distinct from the reevaluation and supported by documentation. CMS reduces practice expense for the second and later therapy units furnished that day.

What documentation supports 97168?

Document the functional or medical change prompting reassessment, the therapist’s findings and analysis, and how the plan or goals were revised. Routine progress without a reevaluation and plan-of-care analysis does not support this service.

Does 97168 have a separate professional component?

No. It is a therapy service, and a professional-component modifier does not apply.

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

Show the CMS file lines behind this rate
RVUs for 97168PPRRVU2026_Oct_nonQPP.csv, line 12,884 (RVU26D)

Open CMS sourceHow we calculate rates

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