Code Reality Check
97161 reimbursement rate: PT evaluation, low complexity
PT evaluation, low complexity (CPT 97161) pays a median $113.58 in Rhode Island and $62.93 in Kentucky, against a Medicare anchor of $97.04. 51 of 51 states clear the publication floor.
spread 1.8x top to bottom
Medicare anchor $97.04
51/51 states published
The 50-state spread
as of 2026-07-15| State | Median | vs Medicare | Band | Rate points | Tier |
|---|---|---|---|---|---|
| Rhode Island | $113.58 | 1.17x | $101–$233 · P90 $233 | 8,096 | Benchmark |
| Maine | $102.43 | 1.06x | $82–$162 · P90 $191 | 11,417 | Benchmark |
| Wisconsin | $101.87 | 1.05x | $82–$231 · P90 $313 | 31,715 | Benchmark |
| South Dakota | $100.28 | 1.03x | $75–$250 · P90 $431 | 282 | Benchmark |
| Wyoming | $91.92 | 0.95x | $82–$107 · P90 $172 | 604 | Benchmark |
| Massachusetts | $91.54 | 0.94x | $75–$179 · P90 $325 | 8,005 | Benchmark |
| Utah | $91.07 | 0.94x | $75–$250 · P90 $431 | 1,027 | Benchmark |
| Georgia | $88.93 | 0.92x | $86–$120 · P90 $206 | 67,324 | Benchmark |
| Nebraska | $88.86 | 0.92x | $75–$250 · P90 $500 | 559 | Benchmark |
| New Hampshire | $87.39 | 0.90x | $87–$105 · P90 $271 | 7,783 | Benchmark |
| North Carolina | $86.49 | 0.89x | $68–$162 · P90 $162 | 96,886 | Benchmark |
| Alabama | $85.63 | 0.88x | $75–$122 · P90 $250 | 2,153 | Benchmark |
| Hawaii | $85.56 | 0.88x | $75–$233 · P90 $403 | 946 | Benchmark |
| Delaware | $85.50 | 0.88x | $75–$169 · P90 $333 | 620 | Benchmark |
| Montana | $85.46 | 0.88x | $75–$162 · P90 $253 | 440 | Benchmark |
| Michigan | $84.77 | 0.87x | $72–$177 · P90 $277 | 5,503 | Benchmark |
| Mississippi | $84.54 | 0.87x | $73–$162 · P90 $333 | 630 | Benchmark |
| Oregon | $84.42 | 0.87x | $75–$202 · P90 $431 | 1,687 | Benchmark |
| Virginia | $83.11 | 0.86x | $75–$96 · P90 $157 | 21,918 | Benchmark |
| North Dakota | $83.06 | 0.86x | $75–$190 · P90 $250 | 328 | Benchmark |
| Maryland | $82.89 | 0.85x | $75–$135 · P90 $250 | 4,519 | Benchmark |
| Washington | $82.53 | 0.85x | $75–$226 · P90 $431 | 3,338 | Benchmark |
| Pennsylvania | $81.71 | 0.84x | $75–$130 · P90 $250 | 10,793 | Benchmark |
| Oklahoma | $81.69 | 0.84x | $69–$167 · P90 $333 | 1,073 | Benchmark |
| Minnesota | $81.61 | 0.84x | $75–$106 · P90 $221 | 6,382 | Benchmark |
| Illinois | $81.61 | 0.84x | $60–$147 · P90 $256 | 11,511 | Benchmark |
| Iowa | $81.61 | 0.84x | $69–$162 · P90 $250 | 1,047 | Benchmark |
| Texas | $81.56 | 0.84x | $75–$202 · P90 $335 | 10,010 | Benchmark |
| Louisiana | $81.39 | 0.84x | $75–$186 · P90 $431 | 1,422 | Benchmark |
| Tennessee | $81.31 | 0.84x | $70–$106 · P90 $184 | 5,934 | Benchmark |
| District of Columbia | $81.11 | 0.84x | $75–$132 · P90 $250 | 1,327 | Benchmark |
| New Mexico | $80.96 | 0.83x | $75–$162 · P90 $389 | 933 | Benchmark |
| Arizona | $80.84 | 0.83x | $75–$165 · P90 $327 | 3,513 | Benchmark |
| South Carolina | $80.47 | 0.83x | $68–$156 · P90 $178 | 6,370 | Benchmark |
| Nevada | $80.43 | 0.83x | $75–$163 · P90 $348 | 1,476 | Benchmark |
| Alaska | $79.89 | 0.82x | $75–$160 · P90 $236 | 323 | Benchmark |
| California | $79.65 | 0.82x | $75–$315 · P90 $431 | 109,669 | Benchmark |
| Idaho | $79.46 | 0.82x | $75–$157 · P90 $250 | 550 | Benchmark |
| Florida | $79.46 | 0.82x | $75–$146 · P90 $250 | 16,657 | Benchmark |
| Ohio | $78.94 | 0.81x | $67–$120 · P90 $236 | 55,751 | Benchmark |
| West Virginia | $78.94 | 0.81x | $68–$84 · P90 $162 | 1,537 | Benchmark |
| New Jersey | $76.90 | 0.79x | $75–$108 · P90 $247 | 15,501 | Benchmark |
| Connecticut | $75.10 | 0.77x | $75–$149 · P90 $261 | 5,796 | Benchmark |
| Arkansas | $75.00 | 0.77x | $58–$146 · P90 $253 | 1,001 | Benchmark |
| New York | $75.00 | 0.77x | $75–$81 · P90 $225 | 324,581 | Benchmark |
| Vermont | $75.00 | 0.77x | $71–$87 · P90 $154 | 1,338 | Benchmark |
| Indiana | $73.86 | 0.76x | $59–$96 · P90 $130 | 47,681 | Benchmark |
| Kansas | $73.64 | 0.76x | $52–$89 · P90 $247 | 1,339 | Benchmark |
| Colorado | $70.00 | 0.72x | $70–$85 · P90 $165 | 10,045 | Benchmark |
| Missouri | $63.19 | 0.65x | $52–$113 · P90 $174 | 37,548 | Benchmark |
| Kentucky | $62.93 | 0.65x | $57–$75 · P90 $97 | 20,238 | Benchmark |
Payer-blind local peer percentiles per state, full verified distribution. Publication floor: 11 verified rate points and a non-degenerate spread; the P25–P75 band unlocks at 25 points, P90 at 100 (a smaller cell's P90 is one contract, not a statistic).
Documented reimbursement figures are modeled, not guaranteed. Derived from federally mandated Transparency in Coverage data (45 CFR 147.212). No PHI.
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Cite this page
Source: Reddenda Code Reality Check, CPT 97161. Reddenda. https://reddenda.health/code/97161/
Derivation federally mandated TiC MRFs, verified to provider identity987,126 verified rate points across 51 statesas of 2026-07-15 · methodology v1.0