How much does Medicare pay for CPT 97162?

Medicare allowed an average of $99.21 per service and paid $72.84 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $184.59, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 97162?

Evaluation for physical therapy, typically 30 minutes. It was billed 1,346,460 times to 1,241,640 Medicare beneficiaries by 36,625 providers in 2024.

Does 97162 pay differently in an office than a hospital?

Yes. The allowed amount averaged $99.21 in an office setting and $95.48 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 97162 most?

Physical Therapist in Private Practice, with 1,330,572 services from 36,202 clinicians. Next are Orthopedic Surgery, Physical Medicine and Rehabilitation, Internal Medicine.

CPT 97162

Evaluation for physical therapy, typically 30 minutes

$99.21Medicare-allowed amount per service, averaged across 1,346,460 services

Providers submitted

$184.59

Asking price, not received

Medicare allowed

$99.21

The fee schedule figure

Medicare paid

$72.84

Balance is patient coinsurance

Providers submitted an average of $184.59 for this code and Medicare allowed $99.21 — 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 $72.84 (73%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $99.21
Hospital / facility: $95.48

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. 1,346,186 services were billed in an office setting and 274 in a facility.

Services: 1,346,460
Beneficiaries: 1,241,640
Providers billing it: 36,625
Total allowed: $133,582,297

What Medicare pays for CPT 97162

Across 1,346,460 services billed by 36,625 providers to 1,241,640 beneficiaries, Medicare allowed an average of $99.21 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 97162

Specialty	Services	Beneficiaries	Avg allowed	Providers
Physical Therapist in Private Practice	1,330,572	1,227,051	$99.22	36,202
Orthopedic Surgery	6,579	6,219	$97.17	165
Physical Medicine and Rehabilitation	3,909	3,590	$101.43	95
Internal Medicine	1,068	797	$101.99	17
Family Practice	834	728	$93.81	25
Neurology	742	645	$96.87	25
Otolaryngology	567	562	$97.25	14
Interventional Pain Management	364	340	$96.22	8
Podiatry	331	315	$102.17	13
Pain Management	227	203	$95.56	6
Nurse Practitioner	210	181	$79.42	8
Hand Surgery	167	164	$96.98	7
Occupational Therapist in Private Practice	131	126	$96.89	7
Sports Medicine	93	92	$105.77	3
Anesthesiology	84	81	$97.29	4

97162 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	160,298	$106.95	$71.57	3,499
New York	104,391	$106.55	$73.24	2,595
Florida	86,158	$96.71	$72.47	1,679
New Jersey	65,177	$105.54	$73.16	1,920
Texas	60,957	$96.21	$72.57	1,704
Illinois	55,913	$99.32	$72.23	1,724
Pennsylvania	49,473	$97.83	$72.46	1,432
Virginia	44,467	$98.95	$72.28	1,147
Maryland	42,192	$103.45	$72.58	1,101
North Carolina	37,214	$94.68	$72.60	1,126
Georgia	36,864	$94.55	$73.01	1,032
Arizona	35,644	$96.94	$71.76	914
Washington	33,762	$101.70	$70.42	1,068
Tennessee	30,387	$92.49	$72.65	884
Massachusetts	29,695	$103.86	$71.57	838
Michigan	28,287	$96.84	$72.33	1,026
Ohio	27,830	$94.34	$72.46	795
South Carolina	27,189	$93.44	$73.12	706
Colorado	26,247	$100.08	$71.43	852
Indiana	23,241	$94.32	$71.88	630
Wisconsin	22,015	$95.85	$70.65	806
Oregon	20,940	$97.95	$70.01	634
Iowa	20,513	$93.73	$72.01	609
Missouri	18,701	$94.05	$72.54	575
Alabama	17,374	$91.19	$72.87	488
Kentucky	17,061	$92.35	$72.29	487
Kansas	15,686	$93.11	$71.84	425
Louisiana	15,249	$92.33	$72.82	403
Oklahoma	14,950	$92.27	$72.48	371
Mississippi	14,858	$90.36	$73.32	334
Minnesota	14,661	$97.85	$71.07	525
Utah	13,963	$94.79	$72.79	356
Nevada	13,032	$98.03	$71.92	322
Connecticut	11,641	$103.55	$72.55	393
Nebraska	10,960	$93.80	$71.82	297
Delaware	10,439	$98.46	$72.84	251
Arkansas	9,831	$90.73	$73.03	277
New Mexico	9,561	$93.70	$71.33	187
Idaho	9,540	$93.16	$70.70	311
Montana	7,947	$97.72	$71.00	258
Wyoming	7,677	$97.61	$71.08	194
New Hampshire	7,509	$99.08	$72.13	219
West Virginia	5,889	$92.14	$71.46	165
Hawaii	5,678	$103.05	$70.38	182
Maine	5,362	$96.78	$71.03	207
Rhode Island	4,544	$101.52	$72.51	158
South Dakota	4,173	$97.40	$72.00	146
Alaska	3,448	$122.59	$71.30	133
Vermont	2,986	$97.40	$68.31	88
District of Columbia	1,830	$107.83	$72.55	48
North Dakota	1,522	$97.33	$70.76	57
Puerto Rico	719	$97.63	$72.35	25
Guam	336	$104.91	$73.01	6
U.S. Virgin Islands	330	$99.09	$67.79	10
AE	45	$94.69	$67.43	2
XX	39	$98.96	$74.10	1

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
97161Evaluation for physical therapy$99.49
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.