Medicare Physician Fee Schedule · Q3 2026 release
CPT 97161 in Miami, FL
Physical therapy evaluation in ZIPs including 33131, 33139, and 33130
09102-04
Status A
Medicare calculates a national payment amount for this code and pays it separately when the service is covered.
Full definition →
102.5% of the $97.86 national baseline
( Work1.54 × 1.000 + Practice exp.1.38 × 1.041 + Malpractice0.01 × 2.529 ) × Conv. factor$33.4009 = $100.27
- Code
- 97161
- DOS
- Not selected; uses this release’s rates
- Locality
- MIAMI (FL)
- Setting
- Office (non-facility)
- Participation
- Participating provider
- Modifiers
- None
- Units
- 1
- Release
- Q3 2026, revision 1
- Sequestration
- Shown separately from the allowed amount
Citations
-
Supplies the RVUs and PFS status for this code and component.
Physician relative value file (PPRRVU)Q3 2026 · revision 1
Latest revision of this release
Release period: July 1 – September 30, 2026
Record details
PPRRVU2026_Jul_nonQPP.csv in rvu26c-updated-06-30-2026.zip (row 12,816)- hcpcs (col 1)
- 97161
- modifier (col 2)
- blank
- status_code (col 4)
- A
- work_rvu (col 6)
- 1.54
- pe_rvu_nonfacility (col 7)
- 1.38
- pe_rvu_facility (col 9)
- 1.38
- mp_rvu (col 11)
- 0.01
SHA-256: b7d197e73211ef6854c213c267d5fa9dec8df995db8e1ee7d44c0556ad7cee21
-
Supplies the geographic adjustment factors for this locality.
Geographic practice cost indices (GPCI)Q3 2026 · revision 1
Latest revision of this release
Release period: July 1 – September 30, 2026
Record details
GPCI2026.csv in rvu26c-updated-06-30-2026.zip (row 42)- mac (col 1)
- 09102
- locality_code (col 3)
- 04
- work_gpci (col 5)
- 1
- pe_gpci (col 6)
- 1.041
- mp_gpci (col 7)
- 2.529
SHA-256: 7850e2987d12e46930e49033f96829b5ae11f60dd1f19965329b38cf08b05264
-
Supplies the dollar conversion factor used in the formula.
Physician relative value file (PPRRVU)Q3 2026 · revision 1
Latest revision of this release
Release period: July 1 – September 30, 2026
Record details
PPRRVU2026_Jul_nonQPP.csv in rvu26c-updated-06-30-2026.zip (row 11)- conversion_factor (col 26)
- 33.4009
SHA-256: b7d197e73211ef6854c213c267d5fa9dec8df995db8e1ee7d44c0556ad7cee21
The Medicare allowed amount is $100.27 in the Office (non-facility) and Facility settings, under the Q3 2026 Physician Fee Schedule. This is the fee schedule amount before sequestration and before any deductible or coinsurance is applied—not necessarily what a specific claim pays.
Q3 2026 · Locality 09102-04 · Participating · Whole service · Sequestration excluded
What Medicare locality is Miami, FL in? Copy link
Miami, FL is in CMS payment locality Miami (09102-04). The same amount applies everywhere in it.
Confirm the locality before using this amount. A split ZIP needs ZIP+4 for an exact match.
ZIP codes in this payment locality (145)
The CMS ZIP-to-locality crosswalk maps 145 ZIP codes to this payment locality. Use this amount only after you confirm the service location is in this locality.
45 more ZIP codes map to this locality. The Miami, FL locality page lists the full set.
Which ZIP codes does the Miami, FL rate for 97161 cover?
The CMS ZIP-to-locality crosswalk maps 145 ZIP codes to this payment locality, and 97161 has the same amount in every one of them. Examples include 33001, 33002, 33010, 33011, 33012, 33013.
How locality affects the amount Copy link
Office (non-facility) · Q3 2026 · Participating · Whole service
Each of this locality's geographic practice cost indices (GPCIs) scales one RVU component before the conversion factor is applied. Together they put Miami, FL 2.5% above the national baseline.
Why is the 97161 rate in Miami, FL different from the national amount?
The national figure is a GPCI 1.000 baseline, not an amount any provider is paid. This locality's geographic practice cost indices—work 1.000, practice expense 1.041, malpractice 2.529—scale each RVU component before the conversion factor is applied, which is why the Miami, FL amount is higher than the $97.86 baseline.
Formula and inputs Copy link
For the office (non-facility) amount, each of 97161's RVU components is multiplied by its Miami, FL GPCI; the products are summed and multiplied by the conversion factor.
- Code
- 97161
- DOS
- Not selected; uses this release’s rates
- Locality
- MIAMI (FL)
- Setting
- Office (non-facility)
- Participation
- Participating provider
- Modifiers
- None
- Units
- 1
- Release
- Q3 2026, revision 1
- Sequestration
- Shown separately from the allowed amount
Formula
(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor
Localis calculated this from CMS’s published inputs. Select an underlined value to see where it comes from.
| Component | RVU | × GPCI | = Adjusted |
|---|---|---|---|
| Work | 1.54 | × 1.000 | 1.5400 |
| Practice expense · Office (non-facility) | 1.38 | × 1.041 | 1.4366 |
| Malpractice | 0.01 | × 2.529 | 0.0253 |
| Sum of adjusted RVUs | 3.0019 | ||
| × 33.4009 conversion factor = formula amount | $100.27 | ||
Component subtotals show four decimals. The formula amount is rounded to cents before any later adjustment.
-
Locality-adjusted allowed amount $100.27
After applicable fee-schedule adjustments; sequestration excluded
Citations
-
Supplies the RVUs and PFS status for this code and component.
Physician relative value file (PPRRVU)Q3 2026 · revision 1
Latest revision of this release
Release period: July 1 – September 30, 2026
Record details
PPRRVU2026_Jul_nonQPP.csv in rvu26c-updated-06-30-2026.zip (row 12,816)- hcpcs (col 1)
- 97161
- modifier (col 2)
- blank
- status_code (col 4)
- A
- work_rvu (col 6)
- 1.54
- pe_rvu_nonfacility (col 7)
- 1.38
- pe_rvu_facility (col 9)
- 1.38
- mp_rvu (col 11)
- 0.01
SHA-256: b7d197e73211ef6854c213c267d5fa9dec8df995db8e1ee7d44c0556ad7cee21
-
Supplies the geographic adjustment factors for this locality.
Geographic practice cost indices (GPCI)Q3 2026 · revision 1
Latest revision of this release
Release period: July 1 – September 30, 2026
Record details
GPCI2026.csv in rvu26c-updated-06-30-2026.zip (row 42)- mac (col 1)
- 09102
- locality_code (col 3)
- 04
- work_gpci (col 5)
- 1
- pe_gpci (col 6)
- 1.041
- mp_gpci (col 7)
- 2.529
SHA-256: 7850e2987d12e46930e49033f96829b5ae11f60dd1f19965329b38cf08b05264
-
Supplies the dollar conversion factor used in the formula.
Physician relative value file (PPRRVU)Q3 2026 · revision 1
Latest revision of this release
Release period: July 1 – September 30, 2026
Record details
PPRRVU2026_Jul_nonQPP.csv in rvu26c-updated-06-30-2026.zip (row 11)- conversion_factor (col 26)
- 33.4009
SHA-256: b7d197e73211ef6854c213c267d5fa9dec8df995db8e1ee7d44c0556ad7cee21
Participating, non-participating and limiting charge Copy link
All figures are for the office (non-facility) setting in Miami, FL. Medicare pays part of the allowed amount and the patient pays the rest; the rows below show each figure. See how the limiting charge and sequestration are derived.
| Participating allowed amount The fee schedule amount a participating provider accepts as payment in full. | $100.27 |
|---|---|
| Non-participating allowed amount 95% of the participating amount. | $95.26 |
| Limiting charge Ceiling a non-participating provider may bill the patient on an unassigned claim—115% of the non-participating amount. | $109.55 |
| Medicare share 80% of the allowed amount, once the annual Part B deductible is met. | $80.22 |
| Patient coinsurance The remaining 20%. | $20.05 |
| Sequestration adjustment Reduces only Medicare's share—never the allowed amount or the patient's coinsurance. | $1.60 |
| Net Medicare payment Medicare's share after the sequestration reduction. | $78.62 |
What is the non-participating amount and limiting charge for 97161 in Miami, FL?
A non-participating provider is paid $95.26—95% of the $100.27 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $109.55, which is 115% of the non-participating amount.
How much of the Miami, FL 97161 rate does Medicare actually pay?
Medicare pays 80% of the allowed amount ($80.22) once the annual Part B deductible is met, and the beneficiary owes 20% ($20.05). Sequestration reduces Medicare's share by about 2% ($1.60), leaving $78.62. Sequestration never changes the allowed amount itself, which is why it is shown separately here.
Contracted rate: % of Medicare in Miami, FL Copy link
Commercial contracts are often written as a percentage of the Medicare fee schedule. The part that gets misread is which Medicare amount: a contract benchmarked to the fee schedule prices off this locality's allowed amount—$100.27 in the office (non-facility) setting—not the $97.86 national baseline.
Opens the calculator set to Miami, FL and your selected setting, where you can also compare what a payer paid against the expected amount. See how to find your contract's actual percentage.
Compare 97161 in nearby payment localities
Payment localities in the same region as Miami, FL, nearest first. Each amount is that locality's own GPCI-adjusted Office (non-facility) figure for 97161. Neighboring localities often differ.
| Metro | Allowed amount | vs. Miami, FL |
|---|---|---|
| Fort Lauderdale, FL | $98.73 | -1.5% |
| Tampa, FL | $96.00 | -4.3% |
| Atlanta, GA | $98.82 | -1.4% |
| Charleston, SC | $94.31 | -5.9% |
| New Orleans, LA | $95.19 | -5.1% |
| Birmingham, AL | $91.96 | -8.3% |
Every payment locality nationwide is on the CPT 97161 rate map.
Other codes priced in Miami, FL Copy link
Office (non-facility) allowed amounts in this same payment locality, Q3 2026.
| Code and service | Allowed | vs. national |
|---|---|---|
| 97110 Physical Therapy Exercises | $30.13 | +3.7% |
| 97140 Hands-On Physical Therapy | $28.77 | +3.8% |
| 97530 Daily-Activity Therapy | $36.40 | +3.8% |
| 97112 Balance and Coordination Therapy | $33.89 | +3.5% |
| 97162 Detailed Physical Therapy Evaluation | $100.27 | +2.5% |
| 97163 Physical therapy | $100.27 | +2.5% |
| 99213 Routine Follow-Up Office Visit | $101.79 | +6.9% |
| 99214 Long Follow-Up Office Visit | $145.50 | +7.3% |
| 66984 Cataract Surgery | $498.59 | +7.8% |
| 92014 Full Eye Exam, Returning Patient | $132.52 | +4.1% |
| 99204 Long New Patient Office Visit | $193.00 | +8.8% |
| 99212 Brief Follow-Up Office Visit | $63.91 | +7.5% |
Source & method Copy link
Computed from the CMS Medicare Physician Fee Schedule Q3 2026 release: this code's RVUs from the relative value file, multiplied by payment locality 09102-04's GPCIs, then by the 2026 conversion factor of $33.4009. ZIP coverage from the CMS ZIP-to-locality crosswalk, Q3 2026 release. Past releases are never edited, so an amount for an earlier quarter always matches what CMS published for it. Coverage and coding correctness are outside this calculation.
Working a claim with an earlier date of service? The calculator prices 97161 in Miami, FL against the release in effect on that date. Dates in the last 12 months don't need an account; older dates of service need a free account.
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