{
    "code": "97162",
    "coding_system": "CPT",
    "canonical_url": "https://localishealth.com/cpt/97162/2018/A",
    "release_specific_url": "https://localishealth.com/cpt/97162/2018/C",
    "description": "The middle of the three initial physical therapy evaluation levels. It fits a patient whose history includes other conditions or personal factors that complicate the plan, whose examination covers several body systems or sets of measurements, and whose presentation is changing enough to need genuine clinical judgement. Against the low-complexity level it involves more data gathering and a less predictable case; against the high-complexity level the patient is still comparatively stable.",
    "answer": {
        "question": "How much did Medicare pay for CPT 97162 in Q3 2018?",
        "text": "Medicare paid $85.68 for CPT 97162 in the office (non-facility) setting and $85.68 in a facility under the Q3 2018 Physician Fee Schedule, effective July 2018. These are the national allowed amounts before the ~2% sequestration cut and before locality (GPCI) adjustment. This price has been unchanged since Q1 2018, when it increased 3.8%."
    },
    "release": {
        "schedule": "pfs",
        "year": 2018,
        "quarter": "C",
        "label": "Q3 2018",
        "effective": "July 1 – September 30, 2018",
        "revision": 1
    },
    "status": {
        "code": "A",
        "non_facility_payable": true,
        "facility_payable": true
    },
    "national_rates_usd": {
        "office_non_facility": 85.68,
        "facility": 85.68,
        "sequestration_applied": false,
        "gpci": 1
    },
    "rvus": {
        "work": 1.2,
        "practice_expense_non_facility": 1.13,
        "practice_expense_facility": 1.13,
        "malpractice": 0.05
    },
    "formula": "(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor",
    "conversion_factor": 35.9996,
    "source": {
        "label": "Physician relative value file (Q3 2018)",
        "cms_url": "https://www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeesched/downloads/rvu18c1.zip",
        "local_source_url": "https://localishealth.com/sources/physician-fee-schedule/2018/C",
        "file": "PPRRVU18_JUL.csv",
        "row": 16399,
        "sha256": "514e3c115f8e62a35eb5f78fef7ed12ed7b60b22a5fe3f3f1bb5aadf119663c5"
    },
    "modified_at": "2026-08-04T03:08:27+00:00"
}