CPT 97161: Physical Therapy Evaluation, Low Complexity
Medicare pays $101 and commercial payers pay $147 on average nationally for this procedure.
CPT code 97161 denotes a physical therapy evaluation, low complexity, performed by a physical therapist that includes history, observation of clinical stability, and assessment of one to two body structure/function elements (for example joint flexibility, muscle strength, gait, mobility, or neuromuscular function) using standardized tests and measures; the service typically involves 20 minutes face-to-face with the patient or family and is commonly delivered in an outpatient clinic or ambulatory rehabilitation setting.
For related coverage guidance, see recent payer policy updates: Lumbar Microdiscectomy, Artificial Cervical Intervertebral Disc, Lumbar Decompression.
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National Reimbursement Benchmarks
National means place Blue Cross Blue Shield highest at $175.7 and Medicare at $101.4, while BUCA’s average commercial benchmark sits between them at $147.3. That positions Medicare about $46 lower than BUCA and roughly $74 lower than Blue Cross Blue Shield, indicating Medicare reimbursement for CPT 97161 is substantially below typical commercial levels but closer to some large commercial payers.
Dispersion (P75 minus P25) highlights which payers have tighter versus wider spreads: Aetna’s spread is $68.0, Blue Cross Blue Shield $92.3, Cigna $40.5, UnitedHealth Group $39.0, and BUCA $47.0. UnitedHealth Group and Cigna show the tightest mid-distribution spreads (around $39–$41), while Blue Cross Blue Shield is the widest at $92.3, with Aetna also relatively wide at $68.0, suggesting greater variability among commercial contracts for those payers.