# CPT 97168: Re-evaluation of occupational therapy established plan of care

Medicare CPT 97168 pays $68.47 in a non-facility setting and $68.47 in a facility setting under the 2026 Medicare Physician Fee Schedule, before geographic adjustment. After geographic adjustment, state amounts run from $63.22 in Arkansas to $86.70 in Alaska, a 37% spread.

Web page: https://www.med-reveal.com/rates/97168-cpt-fee-schedule
Section: Rehabilitation and Therapy

## Medicare rates

| | Amount |
| --- | --- |
| National non-facility | $68.47 |
| National facility | $68.47 |
| Conversion factor | 33.4009 |
| Release | 2026 Q4 (effective 2026-10-01) |

## By state

| State | Non-facility | Facility |
| --- | --- | --- |
| Alaska | $86.70 | $86.70 |
| District of Columbia | $76.66 | $76.66 |
| California | $76.08 | $76.08 |
| New Jersey | $74.70 | $74.70 |
| Washington | $74.46 | $74.46 |
| New York | $74.28 | $74.28 |
| Massachusetts | $73.79 | $73.79 |
| Hawaii | $73.27 | $73.27 |
| Connecticut | $71.96 | $71.96 |
| Colorado | $71.09 | $71.09 |
| Oregon | $70.57 | $70.57 |
| Maryland | $70.45 | $70.45 |
| Rhode Island | $70.24 | $70.24 |
| New Hampshire | $69.91 | $69.91 |
| Minnesota | $69.28 | $69.28 |
| Florida | $68.91 | $68.91 |
| Puerto Rico | $68.86 | $68.86 |
| Virgin Islands | $68.86 | $68.86 |
| Montana | $68.47 | $68.47 |
| Nevada | $68.45 | $68.45 |
| Wyoming | $68.39 | $68.39 |
| North Dakota | $68.27 | $68.27 |
| South Dakota | $68.25 | $68.25 |
| Delaware | $68.17 | $68.17 |
| Texas | $68.07 | $68.07 |
| Pennsylvania | $68.05 | $68.05 |
| Vermont | $67.95 | $67.95 |
| Virginia | $67.76 | $67.76 |
| Illinois | $67.67 | $67.67 |
| Arizona | $67.31 | $67.31 |
| Georgia | $66.93 | $66.93 |
| Maine | $66.74 | $66.74 |
| Wisconsin | $66.73 | $66.73 |
| Michigan | $66.41 | $66.41 |
| Utah | $66.27 | $66.27 |
| North Carolina | $65.93 | $65.93 |
| South Carolina | $65.68 | $65.68 |
| Indiana | $65.67 | $65.67 |
| New Mexico | $65.54 | $65.54 |
| Missouri | $65.50 | $65.50 |
| Nebraska | $65.49 | $65.49 |
| Idaho | $65.41 | $65.41 |
| Louisiana | $65.35 | $65.35 |
| Ohio | $65.34 | $65.34 |
| Iowa | $65.20 | $65.20 |
| Tennessee | $65.03 | $65.03 |
| Kansas | $64.84 | $64.84 |
| Oklahoma | $64.54 | $64.54 |
| Kentucky | $64.44 | $64.44 |
| West Virginia | $63.89 | $63.89 |
| Alabama | $63.82 | $63.82 |
| Mississippi | $63.37 | $63.37 |
| Arkansas | $63.22 | $63.22 |

## Related codes

- 97165: Occupational therapy evaluation, low complexity — https://www.med-reveal.com/rates/97165-cpt-fee-schedule
- 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
- 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 97168 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