Code Reality Check
97163 reimbursement rate: PT evaluation, high complexity
PT evaluation, high complexity (CPT 97163) pays a median $136.54 in California and $63.08 in Missouri, against a Medicare anchor of $97.04. 51 of 51 states clear the publication floor.
spread 2.2x 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 |
|---|---|---|---|---|---|
| California | $136.54 | 1.41x | $75–$327 · P90 $468 | 94,166 | Benchmark |
| Rhode Island | $111.10 | 1.14x | $101–$233 · P90 $233 | 7,993 | Benchmark |
| Montana | $103.75 | 1.07x | $79–$121 · P90 $206 | 595 | Benchmark |
| New Hampshire | $102.68 | 1.06x | $87–$154 · P90 $172 | 5,737 | Benchmark |
| Maine | $102.43 | 1.06x | $82–$162 · P90 $191 | 11,104 | Benchmark |
| Wyoming | $101.38 | 1.04x | $82–$107 · P90 $164 | 593 | Benchmark |
| Massachusetts | $97.81 | 1.01x | $75–$168 · P90 $254 | 6,629 | Benchmark |
| Washington | $96.47 | 0.99x | $79–$192 · P90 $271 | 4,028 | Benchmark |
| District of Columbia | $93.92 | 0.97x | $79–$116 · P90 $204 | 1,345 | Benchmark |
| Oregon | $93.40 | 0.96x | $75–$167 · P90 $326 | 1,634 | Benchmark |
| Indiana | $91.72 | 0.95x | $68–$96 · P90 $138 | 50,334 | Benchmark |
| Georgia | $89.50 | 0.92x | $86–$138 · P90 $207 | 63,827 | Benchmark |
| North Carolina | $89.16 | 0.92x | $68–$162 · P90 $162 | 97,923 | Benchmark |
| Louisiana | $88.06 | 0.91x | $75–$142 · P90 $204 | 1,546 | Benchmark |
| Utah | $87.29 | 0.90x | $75–$127 · P90 $251 | 1,028 | Benchmark |
| Illinois | $86.58 | 0.89x | $67–$145 · P90 $289 | 11,612 | Benchmark |
| Arizona | $85.81 | 0.88x | $75–$169 · P90 $278 | 3,465 | Benchmark |
| Alabama | $85.63 | 0.88x | $75–$111 · P90 $174 | 2,065 | Benchmark |
| Nebraska | $85.45 | 0.88x | $71–$164 · P90 $245 | 524 | Benchmark |
| Idaho | $85.37 | 0.88x | $74–$162 · P90 $233 | 523 | Benchmark |
| Nevada | $84.53 | 0.87x | $75–$162 · P90 $327 | 1,254 | Benchmark |
| Michigan | $83.49 | 0.86x | $75–$117 · P90 $209 | 5,427 | Benchmark |
| Maryland | $83.11 | 0.86x | $75–$103 · P90 $192 | 4,155 | Benchmark |
| Virginia | $83.11 | 0.86x | $80–$99 · P90 $136 | 17,896 | Benchmark |
| Tennessee | $83.11 | 0.86x | $71–$106 · P90 $164 | 6,022 | Benchmark |
| Delaware | $82.17 | 0.85x | $75–$162 · P90 $206 | 540 | Benchmark |
| Mississippi | $82.14 | 0.85x | $69–$130 · P90 $230 | 607 | Benchmark |
| New Mexico | $81.93 | 0.84x | $75–$127 · P90 $210 | 955 | Benchmark |
| Iowa | $81.61 | 0.84x | $75–$176 · P90 $198 | 1,400 | Benchmark |
| Wisconsin | $81.61 | 0.84x | $71–$273 · P90 $404 | 33,946 | Benchmark |
| Minnesota | $81.61 | 0.84x | $75–$97 · P90 $214 | 5,905 | Benchmark |
| North Dakota | $81.61 | 0.84x | $75–$130 · P90 $190 | 274 | Benchmark |
| South Dakota | $81.61 | 0.84x | $67–$145 · P90 $245 | 302 | Benchmark |
| Hawaii | $81.33 | 0.84x | $75–$132 · P90 $233 | 777 | Benchmark |
| South Carolina | $80.96 | 0.83x | $68–$162 · P90 $204 | 7,798 | Benchmark |
| Alaska | $80.95 | 0.83x | $75–$140 · P90 $198 | 307 | Benchmark |
| New Jersey | $80.95 | 0.83x | $75–$112 · P90 $214 | 14,628 | Benchmark |
| Pennsylvania | $80.95 | 0.83x | $75–$131 · P90 $221 | 8,596 | Benchmark |
| Florida | $80.95 | 0.83x | $75–$107 · P90 $173 | 15,933 | Benchmark |
| Connecticut | $80.95 | 0.83x | $75–$156 · P90 $230 | 5,382 | Benchmark |
| Kansas | $79.11 | 0.82x | $55–$105 · P90 $144 | 1,774 | Benchmark |
| Oklahoma | $79.00 | 0.81x | $68–$111 · P90 $190 | 1,022 | Benchmark |
| Ohio | $78.94 | 0.81x | $79–$123 · P90 $286 | 79,042 | Benchmark |
| West Virginia | $78.94 | 0.81x | $75–$95 · P90 $162 | 1,794 | Benchmark |
| Arkansas | $75.06 | 0.77x | $56–$108 · P90 $172 | 1,026 | Benchmark |
| Vermont | $75.00 | 0.77x | $71–$81 · P90 $122 | 1,185 | Benchmark |
| New York | $75.00 | 0.77x | $75–$81 · P90 $236 | 288,337 | Benchmark |
| Texas | $74.88 | 0.77x | $65–$129 · P90 $189 | 30,594 | Benchmark |
| Colorado | $70.00 | 0.72x | $70–$88 · P90 $147 | 10,313 | Benchmark |
| Kentucky | $63.58 | 0.66x | $58–$76 · P90 $96 | 18,916 | Benchmark |
| Missouri | $63.08 | 0.65x | $49–$113 · P90 $179 | 43,014 | 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 97163. Reddenda. https://reddenda.health/code/97163/
Derivation federally mandated TiC MRFs, verified to provider identity975,792 verified rate points across 51 statesas of 2026-07-15 · methodology v1.0