$94.33
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.
On this page
CMS RVU26D · Effective 2026-10-01
97162 PT evaluation Medicare reimbursement rates in Indiana
Initial physical therapy evaluation of moderate complexity, reported once when a therapist assesses a new episode of care with an evolving presentation and develops a plan of care. Compare 97162 office and facility rates across CMS payment localities in Indiana.
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.
What does Medicare pay for 97162 in Indiana?
Indiana has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$94.33
1 of 1 localities have a supported rate.
Payment area: Indiana
One mapped payment locality.
Facility setting
No supported rate
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Physical therapy
About 97162: Physical therapy evaluation, moderate complexity
Initial physical therapy evaluation of moderate complexity, reported once when a therapist assesses a new episode of care with an evolving presentation and develops a plan of care.
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.
CMS billing rules for 97162
- 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 · 53%
- Practice expense (office) RVU1.38 · 47%
- Malpractice RVU0.01 · 0%
1.5M
Medicare services in 2024 · #104 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.
97162 compared with similar codes
Office rates for Indiana, from the same CMS release.
$94.33
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.
$64.74
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.
$96.81
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.
Compare 97162 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Indiana →
Office / nonfacility
$94.33
Facility
Unavailable
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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 97162 in Indiana.
PPRRVU2026_Oct_nonQPP.csv
12,878
- Code
- 97162
- Physician work
- 1.54
- Practice expense
- 1.38
- Malpractice
- 0.01
GPCI2026.csv
52
- Locality
- Indiana
- Physician work
- 1.000
- Practice expense
- 0.927
- Malpractice
- 0.486
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.54 | × 1.000 | 1.5400 |
| Practice expense | 1.38 | × 0.927 | 1.2793 |
| Malpractice | 0.01 | × 0.486 | 0.0049 |
| Total RVUs | 2.8241 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Indiana$94.33
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.54 | 1 |
| Practice expense | 1.38 | 0.927 |
| Malpractice | 0.01 | 0.486 |
(1.54 × 1 + 1.38 × 0.927 + 0.01 × 0.486) × $33.4009 = $94.33
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.
97162 billing questions
How is moderate complexity distinguished from low complexity?
Moderate complexity requires one or two personal factors or comorbidities affecting the plan, at least three examined elements, an evolving presentation, and moderate decision making supported by a standardized assessment or measurable functional outcome. Use 97161 when the documented evaluation supports the low-complexity level instead.
Does the 30 minutes have to be met to bill 97162?
No. Thirty minutes is typical face-to-face time, not a billing threshold. Select the level from the evaluation components and report one unit for the evaluation.
Can treatment codes be billed on the same day as the evaluation?
Yes. Therapeutic exercise or manual therapy performed in addition to the evaluation may be separately reported when supported by documentation. Evaluation time is not counted toward timed treatment units.
Can 97162 and a re-evaluation be billed together?
97164 is for reassessing a patient under an established PT plan of care, not for the initial evaluation of that same treatment episode. Do not report both for the same evaluation.
What modifier does Medicare expect on this code?
The GP modifier identifies a service under a physical therapy plan of care. The professional component modifier 26 is not used for this therapy evaluation.
How does the multiple procedure reduction affect this evaluation?
When multiple therapy units are billed on the same day, the unit with the highest practice expense receives unreduced practice expense; practice expense is reduced for second and later units. The evaluation may receive reduced practice expense depending on its ranking; work and malpractice values are not reduced by this rule.
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.
12,87597157,,Mult fam adapt bhv tx gdn,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,87697158,,Grp adapt bhv tx by phy/qhp,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,87797161,,Pt eval low complex 20 min,A,,1.54,1.38,,1.38,NA,0.01,2.93,2.93,7,XXX,0.00,0.00,0.00,5,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,87897162,,Pt eval mod complex 30 min,A,,1.54,1.38,,1.38,NA,0.01,2.93,2.93,7,XXX,0.00,0.00,0.00,5,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,87997163,,Pt eval high complex 45 min,A,,1.54,1.38,,1.38,NA,0.01,2.93,2.93,7,XXX,0.00,0.00,0.00,5,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,88097164,,Pt re-eval est plan care,A,,0.96,1.05,,1.05,NA,0.01,2.02,2.02,7,XXX,0.00,0.00,0.00,5,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,88197165,,Ot eval low complex 30 min,A,,1.54,1.46,,1.46,NA,0.01,3.01,3.01,7,XXX,0.00,0.00,0.00,5,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915