How much does Medicare pay for CPT 97167?

Medicare allowed an average of $100.53 per service and paid $75.94 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $183.13, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 97167?

Evaluation for occupational therapy, typically 1 hour. It was billed 15,893 times to 14,527 Medicare beneficiaries by 590 providers in 2024.

Which specialty bills 97167 most?

Occupational Therapist in Private Practice, with 15,574 services from 583 clinicians. Next are Physical Therapist in Private Practice, Orthopedic Surgery, Hand Surgery.

CPT 97167

Evaluation for occupational therapy, typically 1 hour

$100.53Medicare-allowed amount per service, averaged across 15,893 services

Providers submitted

$183.13

Asking price, not received

Medicare allowed

$100.53

The fee schedule figure

Medicare paid

$75.94

Balance is patient coinsurance

Providers submitted an average of $183.13 for this code and Medicare allowed $100.53 — 1.8× 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 $75.94 (76%); the rest is the patient’s coinsurance and deductible.

Services: 15,893
Beneficiaries: 14,527
Providers billing it: 590
Total allowed: $1,597,723

What Medicare pays for CPT 97167

Across 15,893 services billed by 590 providers to 14,527 beneficiaries, Medicare allowed an average of $100.53 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 97167

Specialty	Services	Beneficiaries	Avg allowed	Providers
Occupational Therapist in Private Practice	15,574	14,223	$100.51	583
Physical Therapist in Private Practice	110	108	$100.34	1
Orthopedic Surgery	99	89	$110.01	2
Hand Surgery	82	80	$99.86	2
Physician Assistant	17	16	$70.68	1
Neurology	11	11	$94.89	1

97167 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	1,544	$107.47	$75.39	36
Florida	1,259	$100.32	$76.43	31
New Jersey	1,203	$104.51	$75.28	51
New York	1,085	$112.28	$74.74	46
Texas	1,069	$99.96	$76.70	27
Pennsylvania	1,052	$99.81	$74.48	45
Illinois	905	$101.21	$72.57	36
Maryland	575	$103.58	$74.97	19
Michigan	497	$96.95	$75.97	20
Indiana	492	$93.00	$74.34	23
Georgia	474	$96.73	$76.38	16
North Carolina	461	$95.15	$74.89	16
Virginia	448	$98.87	$71.73	14
Colorado	396	$99.98	$74.41	17
Wisconsin	345	$96.13	$75.36	21
Alabama	266	$92.60	$75.08	8
Louisiana	263	$92.59	$72.96	5
Tennessee	262	$93.02	$75.86	13
South Carolina	249	$94.17	$74.47	12
Utah	243	$96.02	$75.15	10
Connecticut	209	$102.84	$71.74	7
Mississippi	192	$90.77	$72.40	8
Nevada	178	$99.67	$71.38	8
Ohio	174	$95.04	$73.70	10
Massachusetts	165	$108.20	$76.38	7
Kansas	153	$92.92	$73.97	6
Arkansas	141	$89.61	$75.56	7
Washington	138	$103.79	$73.02	6
Delaware	138	$102.10	$75.54	6
Iowa	135	$94.66	$74.18	7
Kentucky	119	$95.41	$73.62	6
Minnesota	112	$99.14	$77.83	7
Missouri	102	$95.35	$75.28	4
Nebraska	99	$94.22	$78.32	6
West Virginia	88	$91.21	$78.51	2
Maine	88	$95.50	$77.18	3
Arizona	82	$97.79	$71.50	3
North Dakota	76	$99.59	$76.92	2
Oregon	72	$98.82	$73.12	3
District of Columbia	59	$101.87	$73.04	2
Puerto Rico	47	$91.07	$76.47	2
Montana	38	$99.31	$68.62	1
Wyoming	34	$97.88	$72.83	1
New Hampshire	34	$98.62	$70.14	2
New Mexico	29	$95.45	$76.74	2
South Dakota	29	$97.77	$78.55	1
Hawaii	26	$100.09	$69.06	1
Alaska	24	$128.45	$79.28	2
Idaho	13	$94.22	$68.01	1
Oklahoma	11	$94.12	$79.33	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
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.