CPT code 97168: OT reevaluation, established plan of care2026 Medicare rate & RVUs in Montana
Occupational therapists report 97168 when reassessing an established plan of care after functional or medical changes warrant renewed analysis and plan revision.
In Montana, Medicare pays $68.47 for 97168 in the office.
Check a contract rate as a % of Medicare · 97168 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
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.
How Montana compares for 97168
Across 109 of 109 payment localities, the office rate for 97168 runs from $63.22 in Arkansas to $87.79 in San Benito County, CA. Montana pays $68.47. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Montana · this page$68.47
- Los Angeles, CA · California$76.28+$7.81
- Washington, DC area · District of Columbia$76.66+$8.19
- Miami, FL · Florida$70.46+$1.99
- Chicago, IL · Illinois$69.31+$0.84
- Manhattan, NY · New York$76.56+$8.09
- Alaska · Alaska$86.70+$18.23
Other areas in Montana first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $63.82 | — |
| ArkansasArkansas | $63.22 | — |
| ArizonaArizona | $67.31 | — |
| Bakersfield, CACalifornia | $72.41 | — |
| Chico, CACalifornia | $72.32 | — |
| El Centro, CACalifornia | $72.33 | — |
| Fresno, CACalifornia | $72.32 | — |
| Hanford, CACalifornia | $72.32 | — |
| Madera, CACalifornia | $72.32 | — |
| Merced, CACalifornia | $72.32 | — |
| Modesto, CACalifornia | $72.32 | — |
| Napa, CACalifornia | $81.80 | — |
| Oxnard, CACalifornia | $75.81 | — |
| Redding, CACalifornia | $72.32 | — |
| Rest of CaliforniaCalifornia | $72.32 | — |
| Riverside, CACalifornia | $72.46 | — |
| Sacramento, CACalifornia | $75.35 | — |
| Salinas, CACalifornia | $75.05 | — |
| San Diego, CACalifornia | $76.35 | — |
| Marin County, CACalifornia | $86.13 | — |
| San Francisco, CACalifornia | $86.12 | — |
| San Benito County, CACalifornia | $87.79 | — |
| Santa Clara County, CACalifornia | $87.74 | — |
| San Luis Obispo, CACalifornia | $73.88 | — |
| Santa Cruz, CACalifornia | $76.75 | — |
| Santa Maria, CACalifornia | $75.20 | — |
| Santa Rosa, CACalifornia | $77.50 | — |
| Stockton, CACalifornia | $72.32 | — |
| Vallejo, CACalifornia | $81.78 | — |
| Visalia, CACalifornia | $72.32 | — |
| Yuba City, CACalifornia | $72.32 | — |
| ColoradoColorado | $71.09 | — |
| ConnecticutConnecticut | $71.96 | — |
| DelawareDelaware | $68.17 | — |
| Fort Lauderdale, FLFlorida | $69.21 | — |
| Rest of FloridaFlorida | $67.05 | — |
| Atlanta, GAGeorgia | $69.21 | — |
| Rest of GeorgiaGeorgia | $64.64 | — |
| Hawaii, Guam, HIHawaii | $73.27 | — |
| IowaIowa | $65.20 | — |
| IdahoIdaho | $65.41 | — |
| East St. Louis, ILIllinois | $65.92 | — |
| Rest of IllinoisIllinois | $65.52 | — |
| Suburban Chicago, ILIllinois | $69.93 | — |
| IndianaIndiana | $65.67 | — |
| KansasKansas | $64.84 | — |
| KentuckyKentucky | $64.44 | — |
| New Orleans, LALouisiana | $66.39 | — |
| Rest of LouisianaLouisiana | $64.31 | — |
| Metropolitan Boston, MAMassachusetts | $76.75 | — |
| Rest of MassachusettsMassachusetts | $70.83 | — |
| Baltimore area, MDMaryland | $71.70 | — |
| Rest of MarylandMaryland | $69.20 | — |
| Rest of MaineMaine | $65.46 | — |
| Southern Maine, MEMaine | $68.02 | — |
| Detroit, MIMichigan | $67.44 | — |
| Rest of MichiganMichigan | $65.38 | — |
| MinnesotaMinnesota | $69.28 | — |
| Metropolitan Kansas City, MOMissouri | $66.26 | — |
| Metropolitan St. Louis, MOMissouri | $66.74 | — |
| Rest of MissouriMissouri | $63.49 | — |
| MississippiMississippi | $63.37 | — |
| North CarolinaNorth Carolina | $65.93 | — |
| North DakotaNorth Dakota | $68.27 | — |
| NebraskaNebraska | $65.49 | — |
| New HampshireNew Hampshire | $69.91 | — |
| Northern New JerseyNew Jersey | $76.29 | — |
| Rest of New JerseyNew Jersey | $73.11 | — |
| New MexicoNew Mexico | $65.54 | — |
| NevadaNevada | $68.45 | — |
| NYC suburbs and Long Island, NYNew York | $77.63 | — |
| Poughkeepsie and northern NYC suburbs, NYNew York | $73.41 | — |
| Queens, NYNew York | $77.24 | — |
| Rest of New YorkNew York | $66.57 | — |
| OhioOhio | $65.34 | — |
| OklahomaOklahoma | $64.54 | — |
| Portland, OROregon | $72.90 | — |
| Rest of OregonOregon | $68.23 | — |
| Metropolitan Philadelphia, PAPennsylvania | $70.59 | — |
| Rest of PennsylvaniaPennsylvania | $65.50 | — |
| Puerto RicoPuerto Rico | $68.86 | — |
| Rhode IslandRhode Island | $70.24 | — |
| South CarolinaSouth Carolina | $65.68 | — |
| South DakotaSouth Dakota | $68.25 | — |
| TennesseeTennessee | $65.03 | — |
| Austin, TXTexas | $70.59 | — |
| Beaumont, TXTexas | $65.20 | — |
| Brazoria, TXTexas | $68.33 | — |
| Dallas, TXTexas | $68.57 | — |
| Fort Worth, TXTexas | $68.21 | — |
| Galveston, TXTexas | $68.42 | — |
| Houston, TXTexas | $68.60 | — |
| Rest of TexasTexas | $66.60 | — |
| UtahUtah | $66.27 | — |
| VirginiaVirginia | $67.76 | — |
| Virgin Islands, VIUnited States Virgin Islands | $68.86 | — |
| VermontVermont | $67.95 | — |
| Rest of WashingtonWashington | $70.72 | — |
| King County, WAWashington | $78.20 | — |
| WisconsinWisconsin | $66.73 | — |
| West VirginiaWest Virginia | $63.89 | — |
| WyomingWyoming | $68.39 | — |
97168 rates by state
Office rate range in each state. Select a state to see its payment localities.
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
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $86.70 | 1 |
| AL | $63.82 | 1 |
| AR | $63.22 | 1 |
| AZ | $67.31 | 1 |
| CA | $72.32–$87.79 | 29 |
| CO | $71.09 | 1 |
| CT | $71.96 | 1 |
| DC | $76.66 | 1 |
| DE | $68.17 | 1 |
| FL | $67.05–$70.46 | 3 |
| GA | $64.64–$69.21 | 2 |
| GU | $73.27 | 1 |
| HI | $73.27 | 1 |
| IA | $65.20 | 1 |
| ID | $65.41 | 1 |
| IL | $65.52–$69.93 | 4 |
| IN | $65.67 | 1 |
| KS | $64.84 | 1 |
| KY | $64.44 | 1 |
| LA | $64.31–$66.39 | 2 |
| MA | $70.83–$76.75 | 2 |
| MD | $69.20–$76.66 | 3 |
| ME | $65.46–$68.02 | 2 |
| MI | $65.38–$67.44 | 2 |
| MN | $69.28 | 1 |
| MO | $63.49–$66.74 | 3 |
| MS | $63.37 | 1 |
| MT | $68.47 | 1 |
| NC | $65.93 | 1 |
| ND | $68.27 | 1 |
| NE | $65.49 | 1 |
| NH | $69.91 | 1 |
| NJ | $73.11–$76.29 | 2 |
| NM | $65.54 | 1 |
| NV | $68.45 | 1 |
| NY | $66.57–$77.63 | 5 |
| OH | $65.34 | 1 |
| OK | $64.54 | 1 |
| OR | $68.23–$72.90 | 2 |
| PA | $65.50–$70.59 | 2 |
| PR | $68.86 | 1 |
| RI | $70.24 | 1 |
| SC | $65.68 | 1 |
| SD | $68.25 | 1 |
| TN | $65.03 | 1 |
| TX | $65.20–$70.59 | 8 |
| UT | $66.27 | 1 |
| VA | $67.76–$76.66 | 2 |
| VI | $68.86 | 1 |
| VT | $67.95 | 1 |
| WA | $70.72–$78.20 | 2 |
| WI | $66.73 | 1 |
| WV | $63.89 | 1 |
| WY | $68.39 | 1 |
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
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.
The exact Montana inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
12,884
- Code
- 97168
- Physician work
- 0.96
- Practice expense
- 1.08
- Malpractice
- 0.01
GPCI2026.csv
71
- Locality
- Montana
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.998
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.96 | × 1.000 | 0.9600 |
| Practice expense | 1.08 | × 1.000 | 1.0800 |
| Malpractice | 0.01 | × 0.998 | 0.0100 |
| Total RVUs | 2.0500 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Montana$68.47
Office: (0.96 × 1 + 1.08 × 1 + 0.01 × 0.998) × $33.4009 = $68.47
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
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 5 | Therapy reduction: practice expense of the second and later units is reduced. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 7 | Therapy 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.
How 97168 has changed in Montana
97168 · Office / nonfacility
$68.47
Effective 2026-10-01
The base rate is $1.05 lower than on 2025-10-01, moving from $69.52 to $68.47 (1.5%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2026
RVU26A
$69.52changed to$68.47
- Conversion factor 32.3465 changed to 33.4009
- Practice expense RVU 1.16 changed to 1.08
- Malpractice RVU 0.03 changed to 0.01
- Malpractice GPCI 0.978 changed to 0.998
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$69.88changed to$69.52
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 1.11 changed to 1.16
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$68.74changed to$69.88
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$70.12changed to$68.74
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 1.07 changed to 1.11
- Malpractice RVU 0.04 changed to 0.03
January 1, 2023
RVU23A
$70.91changed to$70.12
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 1.05 changed to 1.07
- Malpractice GPCI 0.977 changed to 0.978
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$66.61changed to$70.91
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 0.91 changed to 1.05
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$64.57changed to$66.61
- Conversion factor 36.0896 changed to 34.8931
- Work RVU 0.75 changed to 0.96
- Practice expense RVU 1.00 changed to 0.91
- Malpractice RVU 0.03 changed to 0.04
- Malpractice GPCI 1.304 changed to 0.977
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$64.47changed to$64.57
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 0.99 changed to 1.00
- Malpractice GPCI 1.631 changed to 1.304
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$63.68changed to$64.47
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 0.97 changed to 0.99
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$63.37changed to$63.68
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 0.93 changed to 0.97
- Malpractice RVU 0.06 changed to 0.03
- Malpractice GPCI 1.429 changed to 1.631
Held through RVU18B, RVU18C, RVU18D.
April 1, 2017
RVU17B
$53.32changed to$63.37
- Practice expense RVU 0.65 changed to 0.93
Held through RVU17C, RVU17D.
January 1, 2017
RVU17A
No ratechanged to$53.32
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D, RVU16A, RVU16B, RVU16C, RVU16D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $68.47 | Not available in this setting | RVU26D |
| 2026-07-01 | $68.47 | Not available in this setting | RVU26C |
| 2026-04-01 | $68.47 | Not available in this setting | RVU26B |
| 2026-01-01 | $68.47 | Not available in this setting | RVU26A |
| 2025-10-01 | $69.52 | Not available in this setting | RVU25D |
| 2025-07-01 | $69.52 | Not available in this setting | RVU25C |
| 2025-04-01 | $69.52 | Not available in this setting | RVU25B |
| 2025-01-01 | $69.52 | Not available in this setting | RVU25A |
| 2024-10-01 | $69.88 | Not available in this setting | RVU24D |
| 2024-07-01 | $69.88 | Not available in this setting | RVU24C |
| 2024-04-01 | $69.88 | Not available in this setting | RVU24B |
| 2024-03-09 | $69.88 | Not available in this setting | RVU24AR |
| 2024-01-01 | $68.74 | Not available in this setting | RVU24A |
| 2023-10-01 | $70.12 | Not available in this setting | RVU23D |
| 2023-07-01 | $70.12 | Not available in this setting | RVU23C |
| 2023-04-01 | $70.12 | Not available in this setting | RVU23B |
| 2023-01-01 | $70.12 | Not available in this setting | RVU23A |
| 2022-10-01 | $70.91 | Not available in this setting | RVU22D |
| 2022-07-01 | $70.91 | Not available in this setting | RVU22C |
| 2022-04-01 | $70.91 | Not available in this setting | RVU22B |
| 2022-01-01 | $70.91 | Not available in this setting | RVU22A |
| 2021-10-01 | $66.61 | Not available in this setting | RVU21D |
| 2021-07-01 | $66.61 | Not available in this setting | RVU21C |
| 2021-04-01 | $66.61 | Not available in this setting | RVU21B |
| 2021-01-01 | $66.61 | Not available in this setting | RVU21A |
| 2020-10-01 | $64.57 | Not available in this setting | RVU20D |
| 2020-07-01 | $64.57 | Not available in this setting | RVU20C |
| 2020-04-01 | $64.57 | Not available in this setting | RVU20B |
| 2020-01-01 | $64.57 | Not available in this setting | RVU20A |
| 2019-10-01 | $64.47 | Not available in this setting | RVU19D |
| 2019-07-01 | $64.47 | Not available in this setting | RVU19C |
| 2019-04-01 | $64.47 | Not available in this setting | RVU19B |
| 2019-01-01 | $64.47 | Not available in this setting | RVU19A |
| 2018-10-01 | $63.68 | Not available in this setting | RVU18D |
| 2018-07-01 | $63.68 | Not available in this setting | RVU18C |
| 2018-04-01 | $63.68 | Not available in this setting | RVU18B |
| 2018-01-01 | $63.68 | Not available in this setting | RVU18AR1 |
| 2017-10-01 | $63.37 | Not available in this setting | RVU17D |
| 2017-07-01 | $63.37 | Not available in this setting | RVU17C |
| 2017-04-01 | $63.37 | Not available in this setting | RVU17B |
| 2017-01-01 | $53.32 | Not available in this setting | RVU17A |
| 2016-10-01 | Not in this release | Not in this release | RVU16D |
| 2016-07-01 | Not in this release | Not in this release | RVU16C |
| 2016-04-01 | Not in this release | Not in this release | RVU16B |
| 2016-01-01 | Not in this release | Not in this release | RVU16A |
| 2015-10-01 | Not in this release | Not in this release | RVU15D |
| 2015-07-01 | Not in this release | Not in this release | RVU15C |
| 2015-04-01 | Not in this release | Not in this release | RVU15B |
| 2015-01-01 | Not in this release | Not in this release | RVU15A |
| 2014-10-01 | Not in this release | Not in this release | RVU14D |
| 2014-07-01 | Not in this release | Not in this release | RVU14C |
| 2014-04-01 | Not in this release | Not in this release | RVU14B |
| 2014-01-01 | Not in this release | Not in this release | RVU14A |
| 2013-10-01 | Not in this release | Not in this release | RVU13D |
| 2013-07-01 | Not in this release | Not in this release | RVU13C |
| 2013-04-01 | Not in this release | Not in this release | RVU13B |
| 2013-01-01 | Not in this release | Not in this release | RVU13AR |
Where the Montana rate applies
Montana is a Medicare payment area, not a city. Our Census mapping connects it to 497 cities and communities in Montana. Some span more than one payment area; confirm with the service ZIP.
- Absarokee
- Acton
- Alberton
- Alder
- Alzada
- Amsterdam
- Anaconda-Deer Lodge County
- Antelope
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
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