Physical, occupational & speech therapy

97166 - RVUs & Medicare payment (2026)

Occupational therapy evaluation, moderate complexity.

Component	Non-facility	Facility
Work RVU	1.54	1.54
Practice expense RVU	1.46	1.46
Malpractice RVU	0.01	0.01
Total RVUs	3.01	3.01
National payment (CF $33.4009)	$100.54	$100.54
Qualifying APM payment (CF $33.5675)	$101.04	$101.04

How 97166 payment varies by locality

Medicare adjusts payment with geographic practice cost indices, so the same code pays differently across the 109 fee schedule localities. In 2026, non-facility payment for 97166 ranges from $93.50 in Arkansas (AR) to $129.28 in Alaska (AK); calculate 97166 for your locality.

Alaska (AK) $129.28 San Jose-Sunnyvale-Santa Clara (CA) $127.59 San Jose-Sunnyvale-Santa Clara (CA) $127.55 San Francisco-Oakland-Berkeley (CA) $125.24 San Francisco-Oakland-Berkeley (CA) $125.22 Napa (CA) $119.12 Vallejo (CA) $119.10 Seattle (WA) $114.12 National average $100.54 … 97 more localities between … West Virginia (WV) $94.29 Rest Of Missouri (MO) $93.80 Mississippi (MS) $93.67 Arkansas (AR) $93.50

Non-facility payment for 97166 in the 2026 fee schedule ($33.4009 conversion factor), before sequestration. Gray bar = national average.

Global period: XXX

No global period: the global surgery concept does not apply to this code.

Related codes - physical, occupational & speech therapy

97161 · physical therapy evaluation, low complexity
97162 · physical therapy evaluation, moderate complexity
97163 · physical therapy evaluation, high complexity
97164 · physical therapy re-evaluation
97165 · occupational therapy evaluation, low complexity
97167 · occupational therapy evaluation, high complexity
97110 · therapeutic exercise, each 15 minutes
97112 · neuromuscular re-education, each 15 minutes
97116 · gait training, each 15 minutes
97140 · manual therapy, each 15 minutes
97530 · therapeutic activities, each 15 minutes
97535 · self-care and home management training, each 15 minutes
92507 · speech, language, voice treatment, individual
92523 · evaluation of speech sound production and language
92526 · treatment of swallowing or oral feeding function
98940 · chiropractic manipulation, 1-2 spinal regions
98941 · chiropractic manipulation, 3-4 spinal regions
98942 · chiropractic manipulation, 5 spinal regions
97810 · acupuncture without electrical stimulation, initial 15 minutes
97811 · acupuncture without electrical stimulation, each additional 15 minutes
97813 · acupuncture with electrical stimulation, initial 15 minutes
97814 · acupuncture with electrical stimulation, each additional 15 minutes

Frequently asked questions

How much does Medicare pay for 97166 in 2026?

The national non-facility payment is $100.54 and the facility payment is $100.54, using the standard $33.4009 conversion factor. Actual amounts vary by Medicare locality; use the RVU calculator for your area.

What is the work RVU for 97166?

The 2026 work RVU for 97166 is 1.54. Total RVUs are 3.01 in the non-facility setting and 3.01 in the facility setting.

Why are the facility and non-facility amounts different?

Only the practice expense component changes by setting. In an office (non-facility) the practice bears the overhead, so the PE RVU is higher; in a hospital or ASC the facility bills its own overhead separately.

Source: CMS Physician Fee Schedule relative value file (rvu26c.zip, retrieved 2026-07-11). Service description is an original plain-English summary, not CPT descriptor text. CPT® is a registered trademark of the American Medical Association. Amounts are estimates before sequestration and claim-level adjustments.