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CMS RVU26D · Effective 2026-10-01

97168 in Redding

Office / nonfacility

$72.32

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 97168: Occupational therapy plan-of-care reevaluation

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

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.

CMS billing rules for 97168

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 RVU0.96 · 47%
  • Practice expense (office) RVU1.08 · 53%
  • Malpractice RVU0.01 · 0%

41.1K

Medicare services in 2024 · #860 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.

97168 compared with similar codes

Office rates for Redding, from the same CMS release.

97164

PT re-evaluation

Established plan of care

$71.23

97164 is for physical therapy reevaluation of an established plan. Use 97168 for occupational therapy reevaluation.

97165

OT evaluation

Low complexity

$105.94

97165 is an initial OT evaluation at low complexity. Choose 97168 when an established plan is being reassessed after a change in status.

97167

OT evaluation

High complexity

$105.94

97167 is an initial OT evaluation at high complexity. Its complexity level does not make it a substitute for reevaluation of an established plan.

The same code, a different location

How does Redding compare?

In Bakersfield, the office rate for 97168 is $72.41—$0.09 higher than the $72.32 rate in Redding. Both use the same code, release and participation basis.

97168 across payment areas

Same release and payment basis · bars start at $0

  1. Redding · This locality

    $72.32

  2. Bakersfield

    $72.41

    $0.09 higher than Redding

  3. Chico

    $72.32

    The same base rate than Redding

  4. El Centro

    $72.33

    $0.01 higher than Redding

  5. Fresno

    $72.32

    The same base rate than Redding

  6. Hanford-Corcoran

    $72.32

    The same base rate than Redding

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

    $76.28

    $3.96 higher than Redding

Other payment areas listed in California 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, 97168 ranges from $63.22 in Arkansas to $87.79 in San Jose-Sunnyvale-Santa Clara (San Benito Cnty). 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

  • Madera

    California · 97168

    Office

    $72.32

    Facility

    Unavailable

    The same base rate than Redding for the office setting.

  • Merced

    California · 97168

    Office

    $72.32

    Facility

    Unavailable

    The same base rate than Redding for the office setting.

  • Modesto

    California · 97168

    Office

    $72.32

    Facility

    Unavailable

    The same base rate than Redding for the office setting.

  • Napa

    California · 97168

    Office

    $81.80

    Facility

    Unavailable

    $9.48 higher than Redding for the office setting.

  • Oxnard-Thousand Oaks-Ventura

    California · 97168

    Office

    $75.81

    Facility

    Unavailable

    $3.49 higher than Redding for the office setting.

  • Rest Of California

    California · 97168

    Office

    $72.32

    Facility

    Unavailable

    The same base rate than Redding for the office setting.

  • Riverside-San Bernardino-Ontario

    California · 97168

    Office

    $72.46

    Facility

    Unavailable

    $0.14 higher than Redding for the office setting.

  • Sacramento-Roseville-Folsom

    California · 97168

    Office

    $75.35

    Facility

    Unavailable

    $3.03 higher than Redding for the office setting.

  • Salinas

    California · 97168

    Office

    $75.05

    Facility

    Unavailable

    $2.73 higher than Redding for the office setting.

  • San Diego-Chula Vista-Carlsbad

    California · 97168

    Office

    $76.35

    Facility

    Unavailable

    $4.03 higher than Redding for the office setting.

  • San Francisco-Oakland-Berkeley (Marin Cnty)

    California · 97168

    Office

    $86.13

    Facility

    Unavailable

    $13.81 higher than Redding for the office setting.

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

    California · 97168

    Office

    $86.12

    Facility

    Unavailable

    $13.80 higher than Redding for the office setting.

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

    California · 97168

    Office

    $87.79

    Facility

    Unavailable

    $15.47 higher than Redding for the office setting.

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

    California · 97168

    Office

    $87.74

    Facility

    Unavailable

    $15.42 higher than Redding for the office setting.

  • San Luis Obispo-Paso Robles

    California · 97168

    Office

    $73.88

    Facility

    Unavailable

    $1.56 higher than Redding for the office setting.

  • Santa Cruz-Watsonville

    California · 97168

    Office

    $76.75

    Facility

    Unavailable

    $4.43 higher than Redding for the office setting.

  • Santa Maria-Santa Barbara

    California · 97168

    Office

    $75.20

    Facility

    Unavailable

    $2.88 higher than Redding for the office setting.

  • Santa Rosa-Petaluma

    California · 97168

    Office

    $77.50

    Facility

    Unavailable

    $5.18 higher than Redding for the office setting.

  • Stockton

    California · 97168

    Office

    $72.32

    Facility

    Unavailable

    The same base rate than Redding for the office setting.

  • Vallejo

    California · 97168

    Office

    $81.78

    Facility

    Unavailable

    $9.46 higher than Redding for the office setting.

  • Visalia

    California · 97168

    Office

    $72.32

    Facility

    Unavailable

    The same base rate than Redding for the office setting.

  • Yuba City

    California · 97168

    Office

    $72.32

    Facility

    Unavailable

    The same base rate than Redding for the office setting.

  • Dc + Md/Va Suburbs

    District of Columbia · 97168

    Office

    $76.66

    Facility

    Unavailable

    $4.34 higher than Redding for the office setting.

  • Miami

    Florida · 97168

    Office

    $70.46

    Facility

    Unavailable

    $1.86 lower than Redding for the office setting.

  • Chicago

    Illinois · 97168

    Office

    $69.31

    Facility

    Unavailable

    $3.01 lower than Redding for the office setting.

  • Manhattan

    New York · 97168

    Office

    $76.56

    Facility

    Unavailable

    $4.24 higher than Redding for the office setting.

  • Alaska*

    Alaska · 97168

    Office

    $86.70

    Facility

    Unavailable

    $14.38 higher than Redding for the office setting.

  • Alabama

    Alabama · 97168

    Office

    $63.82

    Facility

    Unavailable

    $8.50 lower than Redding for the office setting.

  • Arkansas

    Arkansas · 97168

    Office

    $63.22

    Facility

    Unavailable

    $9.10 lower than Redding for the office setting.

  • Arizona

    Arizona · 97168

    Office

    $67.31

    Facility

    Unavailable

    $5.01 lower than Redding for the office setting.

  • Colorado

    Colorado · 97168

    Office

    $71.09

    Facility

    Unavailable

    $1.23 lower than Redding for the office setting.

  • Connecticut

    Connecticut · 97168

    Office

    $71.96

    Facility

    Unavailable

    $0.36 lower than Redding for the office setting.

  • Delaware

    Delaware · 97168

    Office

    $68.17

    Facility

    Unavailable

    $4.15 lower than Redding for the office setting.

  • Fort Lauderdale

    Florida · 97168

    Office

    $69.21

    Facility

    Unavailable

    $3.11 lower than Redding for the office setting.

  • Rest Of Florida

    Florida · 97168

    Office

    $67.05

    Facility

    Unavailable

    $5.27 lower than Redding for the office setting.

  • Atlanta

    Georgia · 97168

    Office

    $69.21

    Facility

    Unavailable

    $3.11 lower than Redding for the office setting.

  • Rest Of Georgia

    Georgia · 97168

    Office

    $64.64

    Facility

    Unavailable

    $7.68 lower than Redding for the office setting.

  • Hawaii, Guam

    Hawaii · 97168

    Office

    $73.27

    Facility

    Unavailable

    $0.95 higher than Redding for the office setting.

  • Iowa

    Iowa · 97168

    Office

    $65.20

    Facility

    Unavailable

    $7.12 lower than Redding for the office setting.

  • Idaho

    Idaho · 97168

    Office

    $65.41

    Facility

    Unavailable

    $6.91 lower than Redding for the office setting.

  • East St. Louis

    Illinois · 97168

    Office

    $65.92

    Facility

    Unavailable

    $6.40 lower than Redding for the office setting.

  • Rest Of Illinois

    Illinois · 97168

    Office

    $65.52

    Facility

    Unavailable

    $6.80 lower than Redding for the office setting.

  • Suburban Chicago

    Illinois · 97168

    Office

    $69.93

    Facility

    Unavailable

    $2.39 lower than Redding for the office setting.

  • Indiana

    Indiana · 97168

    Office

    $65.67

    Facility

    Unavailable

    $6.65 lower than Redding for the office setting.

  • Kansas

    Kansas · 97168

    Office

    $64.84

    Facility

    Unavailable

    $7.48 lower than Redding for the office setting.

  • Kentucky

    Kentucky · 97168

    Office

    $64.44

    Facility

    Unavailable

    $7.88 lower than Redding for the office setting.

  • New Orleans

    Louisiana · 97168

    Office

    $66.39

    Facility

    Unavailable

    $5.93 lower than Redding for the office setting.

  • Rest Of Louisiana

    Louisiana · 97168

    Office

    $64.31

    Facility

    Unavailable

    $8.01 lower than Redding for the office setting.

  • Metropolitan Boston

    Massachusetts · 97168

    Office

    $76.75

    Facility

    Unavailable

    $4.43 higher than Redding for the office setting.

  • Rest Of Massachusetts

    Massachusetts · 97168

    Office

    $70.83

    Facility

    Unavailable

    $1.49 lower than Redding for the office setting.

  • Baltimore/Surr. Cntys

    Maryland · 97168

    Office

    $71.70

    Facility

    Unavailable

    $0.62 lower than Redding for the office setting.

  • Rest Of Maryland

    Maryland · 97168

    Office

    $69.20

    Facility

    Unavailable

    $3.12 lower than Redding for the office setting.

  • Rest Of Maine

    Maine · 97168

    Office

    $65.46

    Facility

    Unavailable

    $6.86 lower than Redding for the office setting.

  • Southern Maine

    Maine · 97168

    Office

    $68.02

    Facility

    Unavailable

    $4.30 lower than Redding for the office setting.

  • Detroit

    Michigan · 97168

    Office

    $67.44

    Facility

    Unavailable

    $4.88 lower than Redding for the office setting.

  • Rest Of Michigan

    Michigan · 97168

    Office

    $65.38

    Facility

    Unavailable

    $6.94 lower than Redding for the office setting.

  • Minnesota

    Minnesota · 97168

    Office

    $69.28

    Facility

    Unavailable

    $3.04 lower than Redding for the office setting.

  • Metropolitan Kansas City

    Missouri · 97168

    Office

    $66.26

    Facility

    Unavailable

    $6.06 lower than Redding for the office setting.

  • Metropolitan St. Louis

    Missouri · 97168

    Office

    $66.74

    Facility

    Unavailable

    $5.58 lower than Redding for the office setting.

  • Rest Of Missouri

    Missouri · 97168

    Office

    $63.49

    Facility

    Unavailable

    $8.83 lower than Redding for the office setting.

  • Mississippi

    Mississippi · 97168

    Office

    $63.37

    Facility

    Unavailable

    $8.95 lower than Redding for the office setting.

  • Montana**

    Montana · 97168

    Office

    $68.47

    Facility

    Unavailable

    $3.85 lower than Redding for the office setting.

  • North Carolina

    North Carolina · 97168

    Office

    $65.93

    Facility

    Unavailable

    $6.39 lower than Redding for the office setting.

  • North Dakota**

    North Dakota · 97168

    Office

    $68.27

    Facility

    Unavailable

    $4.05 lower than Redding for the office setting.

  • Nebraska

    Nebraska · 97168

    Office

    $65.49

    Facility

    Unavailable

    $6.83 lower than Redding for the office setting.

  • New Hampshire

    New Hampshire · 97168

    Office

    $69.91

    Facility

    Unavailable

    $2.41 lower than Redding for the office setting.

  • Northern Nj

    New Jersey · 97168

    Office

    $76.29

    Facility

    Unavailable

    $3.97 higher than Redding for the office setting.

  • Rest Of New Jersey

    New Jersey · 97168

    Office

    $73.11

    Facility

    Unavailable

    $0.79 higher than Redding for the office setting.

  • New Mexico

    New Mexico · 97168

    Office

    $65.54

    Facility

    Unavailable

    $6.78 lower than Redding for the office setting.

  • Nevada**

    Nevada · 97168

    Office

    $68.45

    Facility

    Unavailable

    $3.87 lower than Redding for the office setting.

  • Nyc Suburbs/Long Island

    New York · 97168

    Office

    $77.63

    Facility

    Unavailable

    $5.31 higher than Redding for the office setting.

  • Poughkpsie/N Nyc Suburbs

    New York · 97168

    Office

    $73.41

    Facility

    Unavailable

    $1.09 higher than Redding for the office setting.

  • Queens

    New York · 97168

    Office

    $77.24

    Facility

    Unavailable

    $4.92 higher than Redding for the office setting.

  • Rest Of New York

    New York · 97168

    Office

    $66.57

    Facility

    Unavailable

    $5.75 lower than Redding for the office setting.

  • Ohio

    Ohio · 97168

    Office

    $65.34

    Facility

    Unavailable

    $6.98 lower than Redding for the office setting.

  • Oklahoma

    Oklahoma · 97168

    Office

    $64.54

    Facility

    Unavailable

    $7.78 lower than Redding for the office setting.

  • Portland

    Oregon · 97168

    Office

    $72.90

    Facility

    Unavailable

    $0.58 higher than Redding for the office setting.

  • Rest Of Oregon

    Oregon · 97168

    Office

    $68.23

    Facility

    Unavailable

    $4.09 lower than Redding for the office setting.

  • Metropolitan Philadelphia

    Pennsylvania · 97168

    Office

    $70.59

    Facility

    Unavailable

    $1.73 lower than Redding for the office setting.

  • Rest Of Pennsylvania

    Pennsylvania · 97168

    Office

    $65.50

    Facility

    Unavailable

    $6.82 lower than Redding for the office setting.

  • Puerto Rico

    Puerto Rico · 97168

    Office

    $68.86

    Facility

    Unavailable

    $3.46 lower than Redding for the office setting.

  • Rhode Island

    Rhode Island · 97168

    Office

    $70.24

    Facility

    Unavailable

    $2.08 lower than Redding for the office setting.

  • South Carolina

    South Carolina · 97168

    Office

    $65.68

    Facility

    Unavailable

    $6.64 lower than Redding for the office setting.

  • South Dakota**

    South Dakota · 97168

    Office

    $68.25

    Facility

    Unavailable

    $4.07 lower than Redding for the office setting.

  • Tennessee

    Tennessee · 97168

    Office

    $65.03

    Facility

    Unavailable

    $7.29 lower than Redding for the office setting.

  • Austin

    Texas · 97168

    Office

    $70.59

    Facility

    Unavailable

    $1.73 lower than Redding for the office setting.

  • Beaumont

    Texas · 97168

    Office

    $65.20

    Facility

    Unavailable

    $7.12 lower than Redding for the office setting.

  • Brazoria

    Texas · 97168

    Office

    $68.33

    Facility

    Unavailable

    $3.99 lower than Redding for the office setting.

  • Dallas

    Texas · 97168

    Office

    $68.57

    Facility

    Unavailable

    $3.75 lower than Redding for the office setting.

  • Fort Worth

    Texas · 97168

    Office

    $68.21

    Facility

    Unavailable

    $4.11 lower than Redding for the office setting.

  • Galveston

    Texas · 97168

    Office

    $68.42

    Facility

    Unavailable

    $3.90 lower than Redding for the office setting.

  • Houston

    Texas · 97168

    Office

    $68.60

    Facility

    Unavailable

    $3.72 lower than Redding for the office setting.

  • Rest Of Texas

    Texas · 97168

    Office

    $66.60

    Facility

    Unavailable

    $5.72 lower than Redding for the office setting.

  • Utah

    Utah · 97168

    Office

    $66.27

    Facility

    Unavailable

    $6.05 lower than Redding for the office setting.

  • Virginia

    Virginia · 97168

    Office

    $67.76

    Facility

    Unavailable

    $4.56 lower than Redding for the office setting.

  • Virgin Islands

    United States Virgin Islands · 97168

    Office

    $68.86

    Facility

    Unavailable

    $3.46 lower than Redding for the office setting.

  • Vermont

    Vermont · 97168

    Office

    $67.95

    Facility

    Unavailable

    $4.37 lower than Redding for the office setting.

  • Rest Of Washington

    Washington · 97168

    Office

    $70.72

    Facility

    Unavailable

    $1.60 lower than Redding for the office setting.

  • Seattle (King Cnty)

    Washington · 97168

    Office

    $78.20

    Facility

    Unavailable

    $5.88 higher than Redding for the office setting.

  • Wisconsin

    Wisconsin · 97168

    Office

    $66.73

    Facility

    Unavailable

    $5.59 lower than Redding for the office setting.

  • West Virginia

    West Virginia · 97168

    Office

    $63.89

    Facility

    Unavailable

    $8.43 lower than Redding for the office setting.

  • Wyoming**

    Wyoming · 97168

    Office

    $68.39

    Facility

    Unavailable

    $3.93 lower than Redding for the office setting.

See how rates vary across the country

97168 · 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.

$63.22

$86.70

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

View all state and territory rates as a table
State / territoryRate 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

Explore 97168 on the national rate map →

Where does this rate apply?

Redding is a Medicare payment area. Our Census mapping connects it to 32 cities and communities in California, 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 California →

Use this rate

What is a percentage of Medicare worth?

Turn a percentage into dollars for 97168 in Redding. This uses the base rate on this page, so the locality and release stay consistent.

Reference amount per service

$79.55

$72.32 × 110% = $79.55

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.

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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 97168 in Redding.

PPRRVU2026_Oct_nonQPP.csv

12,884

Code
97168
Physician work
0.96
Practice expense
1.08
Malpractice
0.01

GPCI2026.csv

19

Locality
Redding
Physician work
1.017
Practice expense
1.096
Malpractice
0.536
Office / nonfacility calculation for 97168 in Redding
ComponentRVULocality factorAdjusted
Physician work0.96× 1.0170.9763
Practice expense1.08× 1.0961.1837
Malpractice0.01× 0.5360.0054
Total RVUs2.1654
Conversion factor× 33.4009

Office / nonfacility rate, Redding$72.32

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

Open 97168 in the RVU calculator →

Explore RVUs, geographic factors and the full formula

Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work0.961.017
Practice expense1.081.096
Malpractice0.010.536

(0.96 × 1.017 + 1.08 × 1.096 + 0.01 × 0.536) × $33.4009 = $72.32

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

97168 · Office / nonfacility

$72.32

Effective 2026-10-01

The base rate is $0.72 lower than on 2025-10-01, moving from $73.04 to $72.32 (1.0%).

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

    $73.04changed to$72.32

    • 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
    • Work GPCI 1.014 changed to 1.017
    • Practice expense GPCI 1.093 changed to 1.096
    • Malpractice GPCI 0.560 changed to 0.536

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    Earliest loaded release: $73.04

    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$72.32Not available in this settingRVU26D
2026-07-01$72.32Not available in this settingRVU26C
2026-04-01$72.32Not available in this settingRVU26B
2026-01-01$72.32Not available in this settingRVU26A
2025-10-01$73.04Not available in this settingRVU25D
2025-07-01$73.04Not available in this settingRVU25C
2025-04-01$73.04Not available in this settingRVU25B
2025-01-01$73.04Not available in this settingRVU25A

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 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 97168PPRRVU2026_Oct_nonQPP.csv, line 12,884 (RVU26D)
Geographic factors for ReddingGPCI2026.csv, line 19 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet