# CPT 97165: Occupational therapy evaluation, low complexity

Medicare CPT 97165 pays $100.54 in a non-facility setting and $100.54 in a facility setting under the 2026 Medicare Physician Fee Schedule, before geographic adjustment. After geographic adjustment, state amounts run from $93.50 in Arkansas to $129.28 in Alaska, a 38% spread.

Web page: https://www.med-reveal.com/rates/97165-cpt-fee-schedule
Section: Rehabilitation and Therapy

## Medicare rates

| | Amount |
| --- | --- |
| National non-facility | $100.54 |
| National facility | $100.54 |
| Conversion factor | 33.4009 |
| Release | 2026 Q4 (effective 2026-10-01) |

## By state

| State | Non-facility | Facility |
| --- | --- | --- |
| Alaska | $129.28 | $129.28 |
| District of Columbia | $112.03 | $112.03 |
| California | $111.16 | $111.16 |
| New Jersey | $109.35 | $109.35 |
| Washington | $108.92 | $108.92 |
| New York | $108.73 | $108.73 |
| Massachusetts | $107.98 | $107.98 |
| Hawaii | $107.08 | $107.08 |
| Connecticut | $105.39 | $105.39 |
| Colorado | $104.20 | $104.20 |
| Oregon | $103.47 | $103.47 |
| Maryland | $103.31 | $103.31 |
| Rhode Island | $103.09 | $103.09 |
| New Hampshire | $102.49 | $102.49 |
| Minnesota | $101.72 | $101.72 |
| Puerto Rico | $101.07 | $101.07 |
| Virgin Islands | $101.07 | $101.07 |
| Florida | $101.02 | $101.02 |
| Montana | $100.54 | $100.54 |
| Nevada | $100.53 | $100.53 |
| Wyoming | $100.45 | $100.45 |
| North Dakota | $100.34 | $100.34 |
| South Dakota | $100.31 | $100.31 |
| Delaware | $100.17 | $100.17 |
| Texas | $100.04 | $100.04 |
| Pennsylvania | $100.03 | $100.03 |
| Vermont | $99.88 | $99.88 |
| Virginia | $99.61 | $99.61 |
| Illinois | $99.37 | $99.37 |
| Arizona | $98.98 | $98.98 |
| Georgia | $98.44 | $98.44 |
| Wisconsin | $98.26 | $98.26 |
| Maine | $98.24 | $98.24 |
| Michigan | $97.70 | $97.70 |
| Utah | $97.58 | $97.58 |
| North Carolina | $97.15 | $97.15 |
| Indiana | $96.81 | $96.81 |
| South Carolina | $96.78 | $96.78 |
| Nebraska | $96.57 | $96.57 |
| New Mexico | $96.56 | $96.56 |
| Missouri | $96.52 | $96.52 |
| Idaho | $96.46 | $96.46 |
| Louisiana | $96.31 | $96.31 |
| Ohio | $96.30 | $96.30 |
| Iowa | $96.19 | $96.19 |
| Tennessee | $95.94 | $95.94 |
| Kansas | $95.69 | $95.69 |
| Oklahoma | $95.24 | $95.24 |
| Kentucky | $95.10 | $95.10 |
| Alabama | $94.30 | $94.30 |
| West Virginia | $94.29 | $94.29 |
| Mississippi | $93.67 | $93.67 |
| Arkansas | $93.50 | $93.50 |

## Related codes

- 97166: Occupational therapy evaluation, moderate complexity — https://www.med-reveal.com/rates/97166-cpt-fee-schedule
- 97167: Occupational therapy evaluation, high complexity — https://www.med-reveal.com/rates/97167-cpt-fee-schedule
- 97168: Re-evaluation of occupational therapy established plan of care — https://www.med-reveal.com/rates/97168-cpt-fee-schedule
- 97535: Self-care/home management training, each 15 minutes — https://www.med-reveal.com/rates/97535-cpt-fee-schedule
- 97537: Community/work reintegration training, each 15 minutes — https://www.med-reveal.com/rates/97537-cpt-fee-schedule
- 97542: Wheelchair management, each 15 minutes — https://www.med-reveal.com/rates/97542-cpt-fee-schedule
- G0129: Occupational therapy services requiring skills of a qualified occupational therapist, per session — https://www.med-reveal.com/rates/G0129-hcpcs-fee-schedule

Commercial negotiated rates for 97165 by payer and state: https://www.med-reveal.com/solutions/rate-benchmarking

## Sources

- CMS Medicare fee schedules (2026 Q4): https://www.cms.gov/medicare/payment/fee-schedules