CPT 97162: Physical Therapy Evaluation, Moderate Complexity
Medicare pays $101 and commercial payers pay $150 on average nationally for this procedure.
CPT code 97162 describes a physical therapy evaluation of moderate complexity in which a licensed provider performs a focused history and examination, observes changes in the patient’s status, assesses three or more elements of body structure/function or activity limitations (for example joint flexibility, muscle strength, gait, mobility, or neuromuscular function) using standardized tests and measures, and applies moderate clinical decision making; the service is typically delivered as a 30-minute, face-to-face physical therapy evaluation in an outpatient clinic, inpatient rehabilitation, or other therapeutic care 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
Medicare's mean rate of $101.4 sits slightly below BUCA's mean commercial benchmark of $149.6, indicating that average commercial payments for CPT 97162 are materially higher than the Medicare average. The gap of $48.2 between BUCA and Medicare highlights a meaningful commercial uplift relative to Medicare’s central tendency, while Medicare’s reported central values (P25 $96, P50 $99, P75 $104) cluster tightly around its mean.
Dispersion (P75 minus P25) varies notably across payers: Aetna’s dispersion is $63.5, Blue Cross Blue Shield’s is $95.5, Cigna’s is $45.0, UnitedHealth Group’s is $38.5, and BUCA’s is $72.5; Medicare’s interquartile spread is $8. These figures show Blue Cross Blue Shield has the widest IQR and UnitedHealth Group the tightest among commercial payers, while Medicare exhibits the least spread overall.