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CMS RVU26D · Effective 2026-10-01

97166 in Delaware

Office / nonfacility

$100.17

Base rate per service

Facility setting

Not available in this setting

Base rate per service

Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.

Occupational therapy

About 97166: Moderate complexity occupational therapy evaluation

Report this occupational therapy evaluation when a moderate-complexity assessment of functional performance, relevant history, and treatment needs supports a plan of care.

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.

CMS billing rules for 97166

Professional and technical components
Therapy service: the professional component modifier does not apply.
Multiple procedures
Therapy multiple procedure payment reduction: practice expense is reduced for the second and later therapy units on the same day.

Where the value comes from

  • Work RVU1.54 · 51%
  • Practice expense (office) RVU1.46 · 49%
  • Malpractice RVU0.01 · 0%

168K

Medicare services in 2024 · #418 by national volume

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.

97166 compared with similar codes

Office rates for Delaware, from the same CMS release.

97165

OT evaluation

Low complexity

$100.17

Choose 97165 for low-complexity evaluation; 97166 reflects moderate complexity, including the supported number of deficits and level of clinical decision-making.

97167

OT evaluation

High complexity

$100.17

Choose 97167 when the evaluation supports high complexity rather than moderate complexity, based on the documented profile, deficits, decision-making, and assistance or task modification.

97168

OT reevaluation

Established plan of care

$68.17

97168 describes re-evaluation of an established plan of care. Use 97166 for a moderate-complexity initial evaluation, not a re-evaluation.

The same code, a different location

How does Delaware compare?

97166 across payment areas

Same release and payment basis · bars start at $0

  1. Delaware · This locality

    $100.17

  2. Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty)

    $111.46

    $11.29 higher than Delaware

  3. Dc + Md/Va Suburbs

    $112.03

    $11.86 higher than Delaware

  4. Miami

    $103.05

    $2.88 higher than Delaware

  5. Chicago

    $101.57

    $1.40 higher than Delaware

  6. Manhattan

    $111.92

    $11.75 higher than Delaware

  7. Alaska*

    $129.28

    $29.11 higher than Delaware

Other payment areas listed in Delaware appear first, followed by selected cross-country examples. The chart compares amounts, not distance.

Across 109 of 109 CMS payment localities with a supported office rate, 97166 ranges from $93.50 in Arkansas to $129.28 in Alaska*. This is a geographic range, not an average.

The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.

Compare all 108 other payment areas

  • Alabama

    Alabama · 97166

    Office

    $94.30

    Facility

    Unavailable

    $5.87 lower than Delaware for the office setting.

  • Arkansas

    Arkansas · 97166

    Office

    $93.50

    Facility

    Unavailable

    $6.67 lower than Delaware for the office setting.

  • Arizona

    Arizona · 97166

    Office

    $98.98

    Facility

    Unavailable

    $1.19 lower than Delaware for the office setting.

  • Bakersfield

    California · 97166

    Office

    $106.06

    Facility

    Unavailable

    $5.89 higher than Delaware for the office setting.

  • Chico

    California · 97166

    Office

    $105.94

    Facility

    Unavailable

    $5.77 higher than Delaware for the office setting.

  • El Centro

    California · 97166

    Office

    $105.94

    Facility

    Unavailable

    $5.77 higher than Delaware for the office setting.

  • Fresno

    California · 97166

    Office

    $105.94

    Facility

    Unavailable

    $5.77 higher than Delaware for the office setting.

  • Hanford-Corcoran

    California · 97166

    Office

    $105.94

    Facility

    Unavailable

    $5.77 higher than Delaware for the office setting.

  • Madera

    California · 97166

    Office

    $105.94

    Facility

    Unavailable

    $5.77 higher than Delaware for the office setting.

  • Merced

    California · 97166

    Office

    $105.94

    Facility

    Unavailable

    $5.77 higher than Delaware for the office setting.

  • Modesto

    California · 97166

    Office

    $105.94

    Facility

    Unavailable

    $5.77 higher than Delaware for the office setting.

  • Napa

    California · 97166

    Office

    $119.12

    Facility

    Unavailable

    $18.95 higher than Delaware for the office setting.

  • Oxnard-Thousand Oaks-Ventura

    California · 97166

    Office

    $110.73

    Facility

    Unavailable

    $10.56 higher than Delaware for the office setting.

  • Redding

    California · 97166

    Office

    $105.94

    Facility

    Unavailable

    $5.77 higher than Delaware for the office setting.

  • Rest Of California

    California · 97166

    Office

    $105.94

    Facility

    Unavailable

    $5.77 higher than Delaware for the office setting.

  • Riverside-San Bernardino-Ontario

    California · 97166

    Office

    $106.09

    Facility

    Unavailable

    $5.92 higher than Delaware for the office setting.

  • Sacramento-Roseville-Folsom

    California · 97166

    Office

    $110.18

    Facility

    Unavailable

    $10.01 higher than Delaware for the office setting.

  • Salinas

    California · 97166

    Office

    $109.73

    Facility

    Unavailable

    $9.56 higher than Delaware for the office setting.

  • San Diego-Chula Vista-Carlsbad

    California · 97166

    Office

    $111.48

    Facility

    Unavailable

    $11.31 higher than Delaware for the office setting.

  • San Francisco-Oakland-Berkeley (Marin Cnty)

    California · 97166

    Office

    $125.24

    Facility

    Unavailable

    $25.07 higher than Delaware for the office setting.

  • San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)

    California · 97166

    Office

    $125.22

    Facility

    Unavailable

    $25.05 higher than Delaware for the office setting.

  • San Jose-Sunnyvale-Santa Clara (San Benito Cnty)

    California · 97166

    Office

    $127.59

    Facility

    Unavailable

    $27.42 higher than Delaware for the office setting.

  • San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)

    California · 97166

    Office

    $127.55

    Facility

    Unavailable

    $27.38 higher than Delaware for the office setting.

  • San Luis Obispo-Paso Robles

    California · 97166

    Office

    $108.03

    Facility

    Unavailable

    $7.86 higher than Delaware for the office setting.

  • Santa Cruz-Watsonville

    California · 97166

    Office

    $111.95

    Facility

    Unavailable

    $11.78 higher than Delaware for the office setting.

  • Santa Maria-Santa Barbara

    California · 97166

    Office

    $109.92

    Facility

    Unavailable

    $9.75 higher than Delaware for the office setting.

  • Santa Rosa-Petaluma

    California · 97166

    Office

    $113.04

    Facility

    Unavailable

    $12.87 higher than Delaware for the office setting.

  • Stockton

    California · 97166

    Office

    $105.94

    Facility

    Unavailable

    $5.77 higher than Delaware for the office setting.

  • Vallejo

    California · 97166

    Office

    $119.10

    Facility

    Unavailable

    $18.93 higher than Delaware for the office setting.

  • Visalia

    California · 97166

    Office

    $105.94

    Facility

    Unavailable

    $5.77 higher than Delaware for the office setting.

  • Yuba City

    California · 97166

    Office

    $105.94

    Facility

    Unavailable

    $5.77 higher than Delaware for the office setting.

  • Colorado

    Colorado · 97166

    Office

    $104.20

    Facility

    Unavailable

    $4.03 higher than Delaware for the office setting.

  • Connecticut

    Connecticut · 97166

    Office

    $105.39

    Facility

    Unavailable

    $5.22 higher than Delaware for the office setting.

  • Fort Lauderdale

    Florida · 97166

    Office

    $101.44

    Facility

    Unavailable

    $1.27 higher than Delaware for the office setting.

  • Rest Of Florida

    Florida · 97166

    Office

    $98.56

    Facility

    Unavailable

    $1.61 lower than Delaware for the office setting.

  • Atlanta

    Georgia · 97166

    Office

    $101.54

    Facility

    Unavailable

    $1.37 higher than Delaware for the office setting.

  • Rest Of Georgia

    Georgia · 97166

    Office

    $95.33

    Facility

    Unavailable

    $4.84 lower than Delaware for the office setting.

  • Hawaii, Guam

    Hawaii · 97166

    Office

    $107.08

    Facility

    Unavailable

    $6.91 higher than Delaware for the office setting.

  • Iowa

    Iowa · 97166

    Office

    $96.19

    Facility

    Unavailable

    $3.98 lower than Delaware for the office setting.

  • Idaho

    Idaho · 97166

    Office

    $96.46

    Facility

    Unavailable

    $3.71 lower than Delaware for the office setting.

  • East St. Louis

    Illinois · 97166

    Office

    $96.97

    Facility

    Unavailable

    $3.20 lower than Delaware for the office setting.

  • Rest Of Illinois

    Illinois · 97166

    Office

    $96.48

    Facility

    Unavailable

    $3.69 lower than Delaware for the office setting.

  • Suburban Chicago

    Illinois · 97166

    Office

    $102.47

    Facility

    Unavailable

    $2.30 higher than Delaware for the office setting.

  • Indiana

    Indiana · 97166

    Office

    $96.81

    Facility

    Unavailable

    $3.36 lower than Delaware for the office setting.

  • Kansas

    Kansas · 97166

    Office

    $95.69

    Facility

    Unavailable

    $4.48 lower than Delaware for the office setting.

  • Kentucky

    Kentucky · 97166

    Office

    $95.10

    Facility

    Unavailable

    $5.07 lower than Delaware for the office setting.

  • New Orleans

    Louisiana · 97166

    Office

    $97.70

    Facility

    Unavailable

    $2.47 lower than Delaware for the office setting.

  • Rest Of Louisiana

    Louisiana · 97166

    Office

    $94.91

    Facility

    Unavailable

    $5.26 lower than Delaware for the office setting.

  • Metropolitan Boston

    Massachusetts · 97166

    Office

    $112.07

    Facility

    Unavailable

    $11.90 higher than Delaware for the office setting.

  • Rest Of Massachusetts

    Massachusetts · 97166

    Office

    $103.88

    Facility

    Unavailable

    $3.71 higher than Delaware for the office setting.

  • Baltimore/Surr. Cntys

    Maryland · 97166

    Office

    $105.00

    Facility

    Unavailable

    $4.83 higher than Delaware for the office setting.

  • Rest Of Maryland

    Maryland · 97166

    Office

    $101.61

    Facility

    Unavailable

    $1.44 higher than Delaware for the office setting.

  • Rest Of Maine

    Maine · 97166

    Office

    $96.51

    Facility

    Unavailable

    $3.66 lower than Delaware for the office setting.

  • Southern Maine

    Maine · 97166

    Office

    $99.97

    Facility

    Unavailable

    $0.20 lower than Delaware for the office setting.

  • Detroit

    Michigan · 97166

    Office

    $99.06

    Facility

    Unavailable

    $1.11 lower than Delaware for the office setting.

  • Rest Of Michigan

    Michigan · 97166

    Office

    $96.34

    Facility

    Unavailable

    $3.83 lower than Delaware for the office setting.

  • Minnesota

    Minnesota · 97166

    Office

    $101.72

    Facility

    Unavailable

    $1.55 higher than Delaware for the office setting.

  • Metropolitan Kansas City

    Missouri · 97166

    Office

    $97.55

    Facility

    Unavailable

    $2.62 lower than Delaware for the office setting.

  • Metropolitan St. Louis

    Missouri · 97166

    Office

    $98.20

    Facility

    Unavailable

    $1.97 lower than Delaware for the office setting.

  • Rest Of Missouri

    Missouri · 97166

    Office

    $93.80

    Facility

    Unavailable

    $6.37 lower than Delaware for the office setting.

  • Mississippi

    Mississippi · 97166

    Office

    $93.67

    Facility

    Unavailable

    $6.50 lower than Delaware for the office setting.

  • Montana**

    Montana · 97166

    Office

    $100.54

    Facility

    Unavailable

    $0.37 higher than Delaware for the office setting.

  • North Carolina

    North Carolina · 97166

    Office

    $97.15

    Facility

    Unavailable

    $3.02 lower than Delaware for the office setting.

  • North Dakota**

    North Dakota · 97166

    Office

    $100.34

    Facility

    Unavailable

    $0.17 higher than Delaware for the office setting.

  • Nebraska

    Nebraska · 97166

    Office

    $96.57

    Facility

    Unavailable

    $3.60 lower than Delaware for the office setting.

  • New Hampshire

    New Hampshire · 97166

    Office

    $102.49

    Facility

    Unavailable

    $2.32 higher than Delaware for the office setting.

  • Northern Nj

    New Jersey · 97166

    Office

    $111.60

    Facility

    Unavailable

    $11.43 higher than Delaware for the office setting.

  • Rest Of New Jersey

    New Jersey · 97166

    Office

    $107.11

    Facility

    Unavailable

    $6.94 higher than Delaware for the office setting.

  • New Mexico

    New Mexico · 97166

    Office

    $96.56

    Facility

    Unavailable

    $3.61 lower than Delaware for the office setting.

  • Nevada**

    Nevada · 97166

    Office

    $100.53

    Facility

    Unavailable

    $0.36 higher than Delaware for the office setting.

  • Nyc Suburbs/Long Island

    New York · 97166

    Office

    $113.33

    Facility

    Unavailable

    $13.16 higher than Delaware for the office setting.

  • Poughkpsie/N Nyc Suburbs

    New York · 97166

    Office

    $107.55

    Facility

    Unavailable

    $7.38 higher than Delaware for the office setting.

  • Queens

    New York · 97166

    Office

    $112.85

    Facility

    Unavailable

    $12.68 higher than Delaware for the office setting.

  • Rest Of New York

    New York · 97166

    Office

    $98.00

    Facility

    Unavailable

    $2.17 lower than Delaware for the office setting.

  • Ohio

    Ohio · 97166

    Office

    $96.30

    Facility

    Unavailable

    $3.87 lower than Delaware for the office setting.

  • Oklahoma

    Oklahoma · 97166

    Office

    $95.24

    Facility

    Unavailable

    $4.93 lower than Delaware for the office setting.

  • Portland

    Oregon · 97166

    Office

    $106.69

    Facility

    Unavailable

    $6.52 higher than Delaware for the office setting.

  • Rest Of Oregon

    Oregon · 97166

    Office

    $100.24

    Facility

    Unavailable

    $0.07 higher than Delaware for the office setting.

  • Metropolitan Philadelphia

    Pennsylvania · 97166

    Office

    $103.53

    Facility

    Unavailable

    $3.36 higher than Delaware for the office setting.

  • Rest Of Pennsylvania

    Pennsylvania · 97166

    Office

    $96.52

    Facility

    Unavailable

    $3.65 lower than Delaware for the office setting.

  • Puerto Rico

    Puerto Rico · 97166

    Office

    $101.07

    Facility

    Unavailable

    $0.90 higher than Delaware for the office setting.

  • Rhode Island

    Rhode Island · 97166

    Office

    $103.09

    Facility

    Unavailable

    $2.92 higher than Delaware for the office setting.

  • South Carolina

    South Carolina · 97166

    Office

    $96.78

    Facility

    Unavailable

    $3.39 lower than Delaware for the office setting.

  • South Dakota**

    South Dakota · 97166

    Office

    $100.31

    Facility

    Unavailable

    $0.14 higher than Delaware for the office setting.

  • Tennessee

    Tennessee · 97166

    Office

    $95.94

    Facility

    Unavailable

    $4.23 lower than Delaware for the office setting.

  • Austin

    Texas · 97166

    Office

    $103.43

    Facility

    Unavailable

    $3.26 higher than Delaware for the office setting.

  • Beaumont

    Texas · 97166

    Office

    $96.12

    Facility

    Unavailable

    $4.05 lower than Delaware for the office setting.

  • Brazoria

    Texas · 97166

    Office

    $100.44

    Facility

    Unavailable

    $0.27 higher than Delaware for the office setting.

  • Dallas

    Texas · 97166

    Office

    $100.76

    Facility

    Unavailable

    $0.59 higher than Delaware for the office setting.

  • Fort Worth

    Texas · 97166

    Office

    $100.27

    Facility

    Unavailable

    $0.10 higher than Delaware for the office setting.

  • Galveston

    Texas · 97166

    Office

    $100.55

    Facility

    Unavailable

    $0.38 higher than Delaware for the office setting.

  • Houston

    Texas · 97166

    Office

    $100.73

    Facility

    Unavailable

    $0.56 higher than Delaware for the office setting.

  • Rest Of Texas

    Texas · 97166

    Office

    $98.02

    Facility

    Unavailable

    $2.15 lower than Delaware for the office setting.

  • Utah

    Utah · 97166

    Office

    $97.58

    Facility

    Unavailable

    $2.59 lower than Delaware for the office setting.

  • Virginia

    Virginia · 97166

    Office

    $99.61

    Facility

    Unavailable

    $0.56 lower than Delaware for the office setting.

  • Virgin Islands

    United States Virgin Islands · 97166

    Office

    $101.07

    Facility

    Unavailable

    $0.90 higher than Delaware for the office setting.

  • Vermont

    Vermont · 97166

    Office

    $99.88

    Facility

    Unavailable

    $0.29 lower than Delaware for the office setting.

  • Rest Of Washington

    Washington · 97166

    Office

    $103.71

    Facility

    Unavailable

    $3.54 higher than Delaware for the office setting.

  • Seattle (King Cnty)

    Washington · 97166

    Office

    $114.12

    Facility

    Unavailable

    $13.95 higher than Delaware for the office setting.

  • Wisconsin

    Wisconsin · 97166

    Office

    $98.26

    Facility

    Unavailable

    $1.91 lower than Delaware for the office setting.

  • West Virginia

    West Virginia · 97166

    Office

    $94.29

    Facility

    Unavailable

    $5.88 lower than Delaware for the office setting.

  • Wyoming**

    Wyoming · 97166

    Office

    $100.45

    Facility

    Unavailable

    $0.28 higher than Delaware for the office setting.

See how rates vary across the country

97166 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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.

$93.50

$129.28

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

View all state and territory rates as a table
State / territoryRate rangeLocalities
AK$129.281
AL$94.301
AR$93.501
AZ$98.981
CA$105.94–$127.5929
CO$104.201
CT$105.391
DC$112.031
DE$100.171
FL$98.56–$103.053
GA$95.33–$101.542
GU$107.081
HI$107.081
IA$96.191
ID$96.461
IL$96.48–$102.474
IN$96.811
KS$95.691
KY$95.101
LA$94.91–$97.702
MA$103.88–$112.072
MD$101.61–$112.033
ME$96.51–$99.972
MI$96.34–$99.062
MN$101.721
MO$93.80–$98.203
MS$93.671
MT$100.541
NC$97.151
ND$100.341
NE$96.571
NH$102.491
NJ$107.11–$111.602
NM$96.561
NV$100.531
NY$98.00–$113.335
OH$96.301
OK$95.241
OR$100.24–$106.692
PA$96.52–$103.532
PR$101.071
RI$103.091
SC$96.781
SD$100.311
TN$95.941
TX$96.12–$103.438
UT$97.581
VA$99.61–$112.032
VI$101.071
VT$99.881
WA$103.71–$114.122
WI$98.261
WV$94.291
WY$100.451

Explore 97166 on the national rate map →

Where does this rate apply?

Delaware is a Medicare payment area. Our Census mapping connects it to 79 cities and communities in Delaware, including the examples shown here.

Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.

Browse all communities in Delaware →

Use this rate

What is a percentage of Medicare worth?

Turn a percentage into dollars for 97166 in Delaware. This uses the base rate on this page, so the locality and release stay consistent.

Reference amount per service

$110.19

$100.17 × 110% = $110.19

A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.

Working with a whole code list?

Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.

Compare your contract offer →

How this local rate is calculated

Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 97166 in Delaware.

PPRRVU2026_Oct_nonQPP.csv

12,882

Code
97166
Physician work
1.54
Practice expense
1.46
Malpractice
0.01

GPCI2026.csv

40

Locality
Delaware
Physician work
1.005
Practice expense
0.988
Malpractice
0.899
Office / nonfacility calculation for 97166 in Delaware
ComponentRVULocality factorAdjusted
Physician work1.54× 1.0051.5477
Practice expense1.46× 0.9881.4425
Malpractice0.01× 0.8990.0090
Total RVUs2.9992
Conversion factor× 33.4009

Office / nonfacility rate, Delaware$100.17

Values as parsed from CMS release RVU26D, effective 2026-10-01. The amount is rounded to the nearest cent only at the end.

Open 97166 in the RVU calculator →

Explore RVUs, geographic factors and the full formula

Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work1.541.005
Practice expense1.460.988
Malpractice0.010.899

(1.54 × 1.005 + 1.46 × 0.988 + 0.01 × 0.899) × $33.4009 = $100.17

The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.

How this rate has changed

97166 · Office / nonfacility

$100.17

Effective 2026-10-01

The base rate is $0.41 lower than on 2025-10-01, moving from $100.58 to $100.17 (0.4%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

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

  1. January 1, 2026

    RVU26A

    $100.58changed to$100.17

    • Conversion factor 32.3465 changed to 33.4009
    • Practice expense RVU 1.53 changed to 1.46
    • Malpractice RVU 0.04 changed to 0.01
    • Work GPCI 1.009 changed to 1.005
    • Practice expense GPCI 0.992 changed to 0.988
    • Malpractice GPCI 0.949 changed to 0.899

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    Earliest loaded release: $100.58

    Held through RVU25B, RVU25C, RVU25D.

Explore release dates and calculate this code in an earlier period →

Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.

Inspect every release and its CMS source
Effective fromOffice / nonfacilityFacilityCMS release
2026-10-01$100.17Not available in this settingRVU26D
2026-07-01$100.17Not available in this settingRVU26C
2026-04-01$100.17Not available in this settingRVU26B
2026-01-01$100.17Not available in this settingRVU26A
2025-10-01$100.58Not available in this settingRVU25D
2025-07-01$100.58Not available in this settingRVU25C
2025-04-01$100.58Not available in this settingRVU25B
2025-01-01$100.58Not available in this settingRVU25A

97166 billing questions

How is 97166 different from 97165?

97166 is for moderate-complexity evaluation, generally supported by 3–5 performance deficits and moderate analytic decision-making. 97165 is the low-complexity level.

When should 97167 be used instead?

Use 97167 when the evaluation supports high rather than moderate complexity, based on the profile and history, performance deficits, clinical decision-making, and assistance or task modification documented.

Is 97166 billed as a timed service?

Report one evaluation, not units for each 15-minute interval. The 45-minute descriptor reflects the typical evaluation time.

Can modifier 26 be appended?

No. CMS identifies 97166 as a therapy service for which the professional-component modifier does not apply.

What documentation supports moderate complexity?

Document the expanded occupational profile and relevant history, functional performance deficits, clinical decision-making, and any comorbidities or assistance and task modifications that affected the evaluation.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.

Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.

RVUs for 97166PPRRVU2026_Oct_nonQPP.csv, line 12,882 (RVU26D)
Geographic factors for DelawareGPCI2026.csv, line 40 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet