Code Reality Check
97162 reimbursement rate: PT evaluation, moderate complexity
PT evaluation, moderate complexity (CPT 97162) pays a median $190.18 in Wisconsin and $63.30 in Missouri, against a Medicare anchor of $97.04. 50 of 51 states clear the publication floor.
spread 3x top to bottom
Medicare anchor $97.04
50/51 states published
The 50-state spread
as of 2026-07-15| State | Median | vs Medicare | Band | Rate points | Tier |
|---|---|---|---|---|---|
| Wisconsin | $190.18 | 1.96x | $82–$277 · P90 $394 | 35,791 | Benchmark |
| Mississippi | $123.88 | 1.28x | $85–$129 · P90 $147 | 4,137 | Benchmark |
| Montana | $118.60 | 1.22x | $96–$138 · P90 $219 | 1,375 | Benchmark |
| South Dakota | $116.21 | 1.20x | $72–$189 · P90 $303 | 1,309 | Benchmark |
| Nebraska | $114.70 | 1.18x | $98–$182 · P90 $207 | 4,191 | Benchmark |
| New Mexico | $114.62 | 1.18x | $81–$119 · P90 $194 | 2,882 | Benchmark |
| West Virginia | $102.72 | 1.06x | $81–$207 · P90 $212 | 3,930 | Benchmark |
| Maine | $102.43 | 1.06x | $82–$161 · P90 $191 | 13,039 | Benchmark |
| Rhode Island | $100.89 | 1.04x | $76–$198 · P90 $233 | 9,576 | Benchmark |
| Oregon | $99.05 | 1.02x | $92–$237 · P90 $274 | 7,702 | Benchmark |
| Wyoming | $98.04 | 1.01x | $82–$119 · P90 $172 | 887 | Benchmark |
| Alabama | $96.79 | 1.00x | $91–$97 · P90 $143 | 7,149 | Benchmark |
| Washington | $95.57 | 0.98x | $96–$174 · P90 $219 | 13,952 | Benchmark |
| Idaho | $95.57 | 0.98x | $75–$117 · P90 $209 | 1,083 | Benchmark |
| Ohio | $93.98 | 0.97x | $67–$166 · P90 $306 | 63,586 | Benchmark |
| Minnesota | $91.50 | 0.94x | $82–$92 · P90 $163 | 16,394 | Benchmark |
| North Dakota | $91.12 | 0.94x | $87–$210 · P90 $303 | 1,309 | Benchmark |
| Massachusetts | $89.11 | 0.92x | $61–$219 · P90 $319 | 21,368 | Benchmark |
| Georgia | $88.96 | 0.92x | $78–$121 · P90 $221 | 81,871 | Benchmark |
| Nevada | $88.02 | 0.91x | $79–$93 · P90 $162 | 4,129 | Benchmark |
| California | $87.86 | 0.91x | $75–$316 · P90 $431 | 153,960 | Benchmark |
| New Hampshire | $87.39 | 0.90x | $75–$105 · P90 $152 | 5,926 | Benchmark |
| District of Columbia | $86.99 | 0.90x | $78–$113 · P90 $182 | 2,592 | Benchmark |
| Utah | $86.97 | 0.90x | $87–$96 · P90 $177 | 4,178 | Benchmark |
| Iowa | $86.65 | 0.89x | $64–$145 · P90 $309 | 4,774 | Benchmark |
| Colorado | $85.00 | 0.88x | $70–$91 · P90 $162 | 16,710 | Benchmark |
| Virginia | $83.11 | 0.86x | $75–$105 · P90 $162 | 30,952 | Benchmark |
| Kansas | $82.06 | 0.85x | $71–$95 · P90 $117 | 4,642 | Benchmark |
| Indiana | $81.99 | 0.84x | $59–$96 · P90 $103 | 65,784 | Benchmark |
| Illinois | $81.90 | 0.84x | $75–$129 · P90 $198 | 30,020 | Benchmark |
| Alaska | $81.85 | 0.84x | $74–$154 · P90 $194 | 443 | Benchmark |
| Arizona | $81.18 | 0.84x | $80–$96 · P90 $198 | 9,843 | Benchmark |
| Hawaii | $80.95 | 0.83x | $73–$130 · P90 $233 | 1,022 | Benchmark |
| Louisiana | $80.51 | 0.83x | $76–$129 · P90 $201 | 5,949 | Benchmark |
| South Carolina | $78.50 | 0.81x | $71–$115 · P90 $169 | 12,102 | Benchmark |
| Maryland | $78.33 | 0.81x | $74–$99 · P90 $162 | 12,683 | Benchmark |
| Pennsylvania | $76.32 | 0.79x | $69–$110 · P90 $174 | 25,347 | Benchmark |
| Michigan | $76.04 | 0.78x | $76–$96 · P90 $175 | 18,602 | Benchmark |
| Tennessee | $76.04 | 0.78x | $64–$106 · P90 $180 | 13,690 | Benchmark |
| New Jersey | $75.57 | 0.78x | $59–$109 · P90 $208 | 28,559 | Benchmark |
| New York | $75.21 | 0.78x | $75–$81 · P90 $208 | 366,419 | Benchmark |
| Connecticut | $75.04 | 0.77x | $74–$188 · P90 $252 | 12,473 | Benchmark |
| Vermont | $75.00 | 0.77x | $73–$85 · P90 $109 | 1,752 | Benchmark |
| Delaware | $74.75 | 0.77x | $63–$139 · P90 $175 | 1,703 | Benchmark |
| Florida | $71.92 | 0.74x | $49–$89 · P90 $162 | 37,048 | Benchmark |
| Arkansas | $70.94 | 0.73x | $71–$114 · P90 $172 | 4,481 | Benchmark |
| Texas | $70.49 | 0.73x | $62–$103 · P90 $178 | 52,625 | Benchmark |
| Oklahoma | $69.37 | 0.71x | $69–$91 · P90 $163 | 4,316 | Benchmark |
| Kentucky | $66.76 | 0.69x | $58–$75 · P90 $101 | 24,284 | Benchmark |
| Missouri | $63.30 | 0.65x | $52–$115 · P90 $176 | 52,573 | 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 97162. Reddenda. https://reddenda.health/code/97162/
Derivation federally mandated TiC MRFs, verified to provider identity1,301,112 verified rate points across 50 statesas of 2026-07-15 · methodology v1.0