How much does Medicare pay for CPT 97163?

Medicare allowed an average of $99.08 per service and paid $73.18 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $196.51, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 97163?

Evaluation for physical therapy, typically 45 minutes. It was billed 186,118 times to 172,258 Medicare beneficiaries by 6,490 providers in 2024.

Does 97163 pay differently in an office than a hospital?

Yes. The allowed amount averaged $99.08 in an office setting and $110.61 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 97163 most?

Physical Therapist in Private Practice, with 183,872 services from 6,407 clinicians. Next are Orthopedic Surgery, Otolaryngology, Physical Medicine and Rehabilitation.

CPT 97163

Evaluation for physical therapy, typically 45 minutes

$99.08Medicare-allowed amount per service, averaged across 186,118 services

Providers submitted

$196.51

Asking price, not received

Medicare allowed

$99.08

The fee schedule figure

Medicare paid

$73.18

Balance is patient coinsurance

Providers submitted an average of $196.51 for this code and Medicare allowed $99.08 — 2.0× 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 $73.18 (74%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $99.08
Hospital / facility: $110.61

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 186,091 services were billed in an office setting and 27 in a facility.

Services: 186,118
Beneficiaries: 172,258
Providers billing it: 6,490
Total allowed: $18,440,571

What Medicare pays for CPT 97163

Across 186,118 services billed by 6,490 providers to 172,258 beneficiaries, Medicare allowed an average of $99.08 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 97163

Specialty	Services	Beneficiaries	Avg allowed	Providers
Physical Therapist in Private Practice	183,872	170,197	$99.12	6,407
Orthopedic Surgery	1,144	1,070	$97.31	37
Otolaryngology	199	198	$94.28	8
Physical Medicine and Rehabilitation	197	187	$96.04	10
Family Practice	160	95	$97.50	4
Internal Medicine	96	81	$99.27	4
Interventional Pain Management	92	87	$93.21	2
Anesthesiology	81	81	$97.14	2
Neurology	47	45	$102.33	3
Occupational Therapist in Private Practice	43	41	$92.93	2
Neurosurgery	43	40	$88.28	2
Rheumatology	30	27	$95.01	2
Cardiology	25	24	$102.24	2
Nurse Practitioner	22	20	$79.33	1
Physician Assistant	21	20	$61.21	1

97163 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	23,860	$106.11	$71.87	666
Illinois	12,216	$100.77	$72.53	394
Florida	11,386	$96.94	$72.62	302
Texas	10,385	$96.34	$73.06	362
New York	9,356	$105.67	$73.10	337
Pennsylvania	8,484	$99.63	$73.11	268
Maryland	7,814	$103.10	$73.54	258
South Carolina	7,102	$93.72	$73.59	205
New Jersey	6,324	$104.24	$73.38	252
Virginia	6,120	$98.28	$72.73	222
Michigan	5,779	$96.89	$71.87	216
Arizona	5,724	$97.13	$72.39	199
Indiana	5,232	$94.43	$71.70	165
Washington	4,360	$101.28	$70.28	189
Georgia	4,246	$94.04	$73.68	177
Tennessee	4,189	$92.64	$73.32	157
Massachusetts	4,023	$105.43	$73.23	143
Colorado	3,958	$100.24	$72.16	164
Delaware	3,572	$100.20	$73.18	88
North Carolina	3,251	$93.68	$73.54	135
Utah	2,610	$93.92	$68.63	89
Ohio	2,409	$94.22	$73.27	103
Nevada	2,319	$98.13	$71.70	94
Wisconsin	2,243	$96.22	$72.03	106
Kentucky	2,009	$92.23	$73.41	85
Oregon	1,900	$97.32	$70.81	81
Louisiana	1,868	$92.35	$73.93	65
Missouri	1,847	$93.69	$73.42	77
New Mexico	1,800	$93.46	$71.70	53
Alabama	1,722	$91.06	$74.00	77
Idaho	1,701	$93.07	$72.12	63
Kansas	1,540	$92.82	$71.58	57
Oklahoma	1,461	$91.35	$73.29	59
Iowa	1,373	$93.89	$73.45	78
Arkansas	1,327	$90.37	$72.96	59
Montana	1,293	$98.11	$69.64	46
Mississippi	1,236	$90.24	$73.89	54
Nebraska	1,034	$93.82	$73.21	47
Hawaii	914	$103.95	$71.72	30
Connecticut	812	$101.88	$72.16	37
Minnesota	746	$97.24	$70.74	34
New Hampshire	701	$97.92	$72.44	31
Alaska	651	$121.60	$72.97	28
Wyoming	590	$97.93	$71.43	32
Maine	548	$96.77	$72.14	28
West Virginia	521	$91.90	$70.64	21
South Dakota	472	$97.48	$72.53	22
Rhode Island	352	$102.66	$70.55	11
Vermont	229	$96.44	$70.34	8
District of Columbia	154	$106.25	$74.35	6
U.S. Virgin Islands	153	$98.60	$72.67	2
Puerto Rico	120	$89.19	$76.30	4
North Dakota	82	$97.03	$74.62	4

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
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

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.