How much does Medicare pay for CPT 97161?

Medicare allowed an average of $99.49 per service and paid $72.88 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $193.09, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 97161?

Evaluation for physical therapy, typically 20 minutes. It was billed 1,576,730 times to 1,455,139 Medicare beneficiaries by 37,020 providers in 2024.

Does 97161 pay differently in an office than a hospital?

Yes. The allowed amount averaged $99.49 in an office setting and $98.20 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 97161 most?

Physical Therapist in Private Practice, with 1,550,739 services from 36,454 clinicians. Next are Orthopedic Surgery, Physical Medicine and Rehabilitation, Family Practice.

CPT 97161

Evaluation for physical therapy, typically 20 minutes

$99.49Medicare-allowed amount per service, averaged across 1,576,730 services

Providers submitted

$193.09

Asking price, not received

Medicare allowed

$99.49

The fee schedule figure

Medicare paid

$72.88

Balance is patient coinsurance

Providers submitted an average of $193.09 for this code and Medicare allowed $99.49 — 1.9× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $72.88 (73%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $99.49
Hospital / facility: $98.20

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 1,575,432 services were billed in an office setting and 1,298 in a facility.

Services: 1,576,730
Beneficiaries: 1,455,139
Providers billing it: 37,020
Total allowed: $156,868,868

What Medicare pays for CPT 97161

Across 1,576,730 services billed by 37,020 providers to 1,455,139 beneficiaries, Medicare allowed an average of $99.49 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 97161

Specialty	Services	Beneficiaries	Avg allowed	Providers
Physical Therapist in Private Practice	1,550,739	1,431,636	$99.51	36,454
Orthopedic Surgery	12,768	11,923	$97.45	284
Physical Medicine and Rehabilitation	4,945	4,381	$99.70	117
Family Practice	1,716	1,614	$97.06	30
Neurology	1,625	906	$97.21	13
Internal Medicine	838	796	$104.21	14
Otolaryngology	562	544	$96.04	17
Pain Management	481	446	$99.29	5
Podiatry	464	443	$101.02	16
Rheumatology	413	383	$101.43	10
Sports Medicine	314	306	$100.85	10
Occupational Therapist in Private Practice	299	284	$100.17	7
Physician Assistant	283	267	$79.36	7
Interventional Pain Management	281	258	$98.51	7
Hand Surgery	270	265	$98.80	9

97161 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	172,353	$107.29	$71.30	3,407
New York	145,739	$106.67	$73.09	3,253
Florida	114,380	$97.43	$72.27	1,805
New Jersey	70,940	$106.38	$72.99	1,854
Illinois	65,862	$98.95	$72.06	1,612
Texas	61,677	$96.08	$72.28	1,517
North Carolina	56,522	$94.84	$72.19	1,318
Arizona	54,392	$96.71	$71.01	1,110
Pennsylvania	51,917	$98.28	$72.55	1,393
Massachusetts	50,962	$103.96	$71.62	1,205
Virginia	47,590	$98.94	$72.56	1,114
Maryland	43,966	$103.87	$72.79	924
Washington	40,392	$101.60	$70.54	1,181
Tennessee	35,674	$92.73	$72.73	843
Georgia	35,358	$94.93	$72.90	827
Ohio	34,303	$94.47	$72.64	830
Minnesota	33,519	$98.29	$71.24	1,026
South Carolina	31,729	$93.91	$72.95	614
Colorado	28,814	$100.29	$72.01	857
Michigan	27,706	$96.95	$72.37	912
Alabama	23,989	$91.10	$73.12	562
Indiana	20,656	$94.13	$71.76	509
Mississippi	19,720	$90.11	$73.14	338
Louisiana	19,599	$91.99	$72.92	469
Arkansas	18,156	$90.40	$72.87	386
Connecticut	17,062	$103.72	$72.83	500
Iowa	16,550	$93.67	$71.19	426
Missouri	16,104	$93.41	$72.57	417
Kentucky	15,667	$92.44	$72.30	388
Nevada	15,443	$98.11	$71.51	326
Nebraska	15,045	$93.94	$70.97	390
Oregon	14,160	$98.47	$71.03	445
Oklahoma	13,233	$92.18	$71.87	313
Kansas	13,076	$93.05	$72.25	291
Utah	12,756	$92.64	$72.66	320
Delaware	12,038	$98.27	$72.64	225
Wisconsin	11,730	$95.31	$70.59	442
Rhode Island	9,941	$101.06	$72.41	278
Montana	9,693	$97.96	$70.00	276
South Dakota	8,163	$96.68	$71.75	187
Idaho	7,918	$93.06	$70.86	220
New Hampshire	7,417	$99.12	$71.58	187
West Virginia	7,342	$91.95	$70.59	181
Hawaii	6,759	$101.82	$71.44	226
New Mexico	6,751	$93.61	$71.49	150
Wyoming	6,662	$97.04	$70.76	175
North Dakota	6,382	$97.63	$71.47	174
Vermont	5,783	$97.27	$68.36	151
Alaska	5,412	$122.82	$71.49	159
Maine	5,254	$96.19	$70.28	183
District of Columbia	2,518	$108.05	$72.85	72
Puerto Rico	1,403	$94.50	$72.04	38
U.S. Virgin Islands	339	$99.26	$65.33	5
Guam	59	$103.56	$69.95	3
XX	46	$99.19	$74.64	1
AE	44	$96.19	$76.82	2

Related codes

97110Therapy procedure$22.78
97112Therapy procedure to re-educate brain-to-nerve-to-muscle function$27.06
97140Therapy procedure$20.62
97116Therapy procedure for walking training$21.87
97150Therapy procedure in a group setting$13.60
97162Evaluation for physical therapy$99.21
97113Therapy procedure$27.67
97130Therapy procedure for a range of mental processes$21.18
97164Re-evaluation for physical therapy$68.54
97124Therapy procedure$25.23
97129Therapy procedure for a range of mental processes$21.82
97163Evaluation for physical therapy$99.08

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.