Billing code 97162: PT evaluationMedicare rate & RVUs

Medicare pays $97.86 for 97162 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 97162 covers

A physical therapist performs this evaluation at the start of a treatment episode, often in a private practice or outpatient clinic. Referrals after a fall, joint replacement, or lumbar strain do not alone establish complexity. The moderate level requires one or two personal factors or comorbidities affecting the plan, examination of at least three elements of body structures and functions, activity limitations, or participation restrictions, an evolving presentation, and moderate clinical decision making supported by a standardized assessment or measurable functional outcome. Face-to-face time is typically about 30 minutes.

Report 97162 once per evaluation, not in 15-minute units; typical time is not a billing threshold. Document how the history, examination, presentation, and decision making support moderate complexity, including relevant comorbidities, findings, outcome measures, goals, and the plan of care. Medicare physical therapy claims use the GP modifier; the professional component modifier 26 is not used for this therapy service. Under Medicare’s therapy multiple procedure payment reduction, the therapy unit with the highest practice expense receives unreduced practice expense; practice expense is reduced for 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.

Where 97162 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

97162 rates by state

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

How the 97162 rate is calculated

Each of 97162’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 97162

The CMS indicators that decide how 97162 is paid alongside other services.

What modifiers do to the payment

97162 compared with similar codes

How to choose

97161PT evaluation

Choose 97161 when the documented evaluation supports low complexity: a stable presentation, no personal factors or comorbidities affecting the plan, examination of one or two elements, and low-complexity decision making.

97163PT evaluation

97163 requires an unstable, unpredictable presentation, three or more complicating personal factors or comorbidities, examination of four or more elements, and high-complexity decision making.

97164PT re-evaluation

97164 applies when a patient under an established PT plan of care needs formal reassessment because of a change in status; 97162 is an initial evaluation for a treatment episode.

97166OT evaluation

97166 is a moderate-complexity occupational therapy evaluation under an OT plan of care, identified on Medicare claims by the GO modifier. 97162 is the corresponding PT evaluation under a GP plan of care.

Codes related to 97162

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