Billing code 97161: PT evaluationMedicare rate & RVUs

Medicare pays $97.86 for 97161 nationally in the office. Local office rates run $91.20–$126.43.

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

What 97161 covers

A physical therapist uses this initial evaluation to assess movement, functional limitations, and rehabilitation needs in private practice, an outpatient clinic, or a hospital outpatient department. Low complexity calls for a history without personal factors or comorbidities affecting the plan, examination of one or two elements, a stable presentation, and low-complexity clinical decision making supported by standardized assessment tools or measurable functional outcomes. An adult with a straightforward musculoskeletal complaint may fit when the documented findings meet these criteria. The therapist uses the findings to establish functional goals and a treatment plan.

Report one unit for the evaluation; approximately 20 minutes face to face is typical, not a billing threshold. Select the level from the documented history, examined elements, presentation, and decision making rather than time or one component alone. Record the findings, assessment measures, goals, and plan of care for physician or nonphysician practitioner certification. Medicare physical therapy claims use modifier GP. This therapy service is billed without separate professional and technical components, so modifier 26 is inappropriate. When multiple therapy units are billed on the same day, the therapy multiple procedure payment reduction reduces 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 97161 pays more and less

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

109 of 109 payment localities

97161 rates by state

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

How the 97161 rate is calculated

Each of 97161’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 97161

The CMS indicators that decide how 97161 is paid alongside other services.

What modifiers do to the payment

97161 compared with similar codes

How to choose

97162PT evaluation

97162 describes a moderate-complexity PT evaluation, generally involving one or two personal factors or comorbidities affecting care, an exam of at least three elements, and an evolving presentation. Choose 97161 when the documented components support low complexity.

97164PT re-evaluation

97164 reassesses a patient under an established PT plan of care. 97161 is an initial low-complexity evaluation used to establish a plan.

97165OT evaluation

97165 is a low-complexity occupational therapy evaluation under an OT plan of care, identified by modifier GO. 97161 is a physical therapy evaluation under a PT plan of care, identified by GP.

Codes related to 97161

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

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