{
    "code": "97162",
    "coding_system": "CPT",
    "canonical_url": "https://localishealth.com/cpt/97162/2019/A",
    "release_specific_url": "https://localishealth.com/cpt/97162/2019/B",
    "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 Q2 2019?",
        "text": "Medicare paid $86.49 for CPT 97162 in the office (non-facility) setting and $86.49 in a facility under the Q2 2019 Physician Fee Schedule, effective April 2019. These are the national allowed amounts before the ~2% sequestration cut and before locality (GPCI) adjustment. This price has been unchanged since Q1 2019, when it increased 0.9%."
    },
    "release": {
        "schedule": "pfs",
        "year": 2019,
        "quarter": "B",
        "label": "Q2 2019",
        "effective": "April 1 – June 30, 2019",
        "revision": 1
    },
    "status": {
        "code": "A",
        "non_facility_payable": true,
        "facility_payable": true
    },
    "national_rates_usd": {
        "office_non_facility": 86.49,
        "facility": 86.49,
        "sequestration_applied": false,
        "gpci": 1
    },
    "rvus": {
        "work": 1.2,
        "practice_expense_non_facility": 1.15,
        "practice_expense_facility": 1.15,
        "malpractice": 0.05
    },
    "formula": "(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor",
    "conversion_factor": 36.0391,
    "source": {
        "label": "Physician relative value file (Q2 2019)",
        "cms_url": "https://www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeesched/downloads/rvu19b.zip",
        "local_source_url": "https://localishealth.com/sources/physician-fee-schedule/2019/B",
        "file": "PPRRVU19_APR.csv",
        "row": 16697,
        "sha256": "b427bbfdcb61b355ba034840681873d1bd6cdcf51752bdae1bab7c5449efc971"
    },
    "modified_at": "2026-08-04T03:08:53+00:00"
}