How much does Medicare pay for CPT 97168?

Medicare allowed an average of $70.85 per service and paid $54.69 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $154.17, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 97168?

Re-evaluation for occupational therapy, typically 30 minutes. It was billed 29,261 times to 18,082 Medicare beneficiaries by 704 providers in 2024.

Which specialty bills 97168 most?

Occupational Therapist in Private Practice, with 28,972 services from 695 clinicians. Next are Orthopedic Surgery, Physical Therapist in Private Practice, Physical Medicine and Rehabilitation.

CPT 97168

Re-evaluation for occupational therapy, typically 30 minutes

$70.85Medicare-allowed amount per service, averaged across 29,261 services

Providers submitted

$154.17

Asking price, not received

Medicare allowed

$70.85

The fee schedule figure

Medicare paid

$54.69

Balance is patient coinsurance

Providers submitted an average of $154.17 for this code and Medicare allowed $70.85 — 2.2× 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 $54.69 (77%); the rest is the patient’s coinsurance and deductible.

Services: 29,261
Beneficiaries: 18,082
Providers billing it: 704
Total allowed: $2,073,142

What Medicare pays for CPT 97168

Across 29,261 services billed by 704 providers to 18,082 beneficiaries, Medicare allowed an average of $70.85 per service. That is 1.6 services per beneficiary, so this is a code patients typically receive more than once. 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 97168

Specialty	Services	Beneficiaries	Avg allowed	Providers
Occupational Therapist in Private Practice	28,972	17,896	$70.96	695
Orthopedic Surgery	100	73	$71.78	4
Physical Therapist in Private Practice	93	36	$68.49	2
Physical Medicine and Rehabilitation	43	36	$0.01	1
Neurology	36	24	$66.22	1
Hand Surgery	17	17	$70.49	1

97168 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	4,742	$76.28	$51.91	101
New Jersey	4,158	$74.51	$53.45	111
New York	3,180	$74.01	$52.60	57
Florida	2,419	$68.66	$53.41	46
Pennsylvania	1,535	$67.05	$53.18	36
Maryland	1,473	$72.63	$51.93	33
Arizona	1,229	$66.77	$52.58	38
Texas	1,045	$66.60	$53.44	27
Virginia	829	$68.53	$52.23	19
North Carolina	543	$63.61	$52.82	12
Nebraska	540	$64.57	$50.33	9
Louisiana	512	$63.84	$53.47	9
Iowa	484	$65.23	$53.13	9
Ohio	458	$66.30	$52.88	14
Kentucky	456	$63.86	$53.92	14
Illinois	454	$69.18	$53.26	12
Colorado	448	$70.46	$51.61	17
Nevada	399	$67.18	$52.45	12
Alaska	362	$85.05	$53.69	10
Massachusetts	316	$72.84	$52.92	9
Tennessee	271	$64.13	$52.45	10
South Carolina	262	$65.30	$54.26	5
Oregon	248	$70.35	$53.31	10
Alabama	246	$63.06	$53.32	10
Missouri	237	$64.53	$53.57	4
Mississippi	219	$63.01	$53.15	5
Washington	197	$70.86	$52.46	4
Michigan	188	$68.29	$50.19	4
Georgia	176	$67.79	$52.78	5
District of Columbia	171	$77.79	$54.08	3
Indiana	136	$65.13	$52.36	5
Maine	133	$65.28	$54.25	3
Wisconsin	132	$64.07	$53.39	7
Kansas	127	$62.94	$54.00	4
Idaho	125	$64.74	$52.24	2
Delaware	124	$69.72	$51.59	4
Utah	117	$64.21	$48.91	6
Montana	108	$68.55	$54.16	3
Oklahoma	99	$62.26	$54.73	2
New Hampshire	95	$69.69	$50.03	2
Wyoming	69	$66.33	$52.46	2
Arkansas	46	$63.11	$49.35	1
New Mexico	38	$64.07	$55.12	1
Minnesota	27	$68.37	$54.64	2
Connecticut	25	$74.61	$45.66	1
Rhode Island	22	$66.67	$54.77	1
Hawaii	15	$69.39	$54.75	1
North Dakota	13	$72.28	$50.49	1
South Dakota	13	$67.55	$51.78	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.