{"procedure":{"code_type":"CPT","code":"97166","lay_name":"Occupational therapy evaluation, moderate complexity","blurb":"First visit with an occupational therapist with a more detailed history and assessment of daily living skills and a plan of care; billed once per evaluation.","slug":"cpt-97166-occupational-therapy-evaluation-moderate-complexity","description":"Occupational Therapy Eval Mod Complex 45 Mins","name_source":"llm:claude-opus-5","name_reviewed":false,"ccs":{"code":"212","label":"Diagnostic physical, occupational, and speech therapy","surgery_flag":"neither"}},"settings":{"outpatient":{"setting":"outpatient","computed_at":"2026-09-25T11:55:12.319193Z","corpus_loaded_through":"2026-09-25T10:46:50.712029Z","filing_date_min":"2023-11-06","filing_date_max":"2026-09-22","checked_from":"2026-09-05T02:07:09.005325Z","checked_through":"2026-09-25T10:46:52.415798Z","n_priced_setters":3956,"n_filed":3523,"n_usable":3337,"n_not_usable":0,"n_labelled":44,"n_no_cash":141,"n_estimated":1,"n_states":50,"cash_p10":103.0,"cash_p20":135.52,"cash_p25":153.19,"cash_p50":231.84,"cash_p75":350.06,"cash_p80":381.5,"cash_p90":539.0,"cash_mean_trimmed":240.08,"gross_p50":391.0,"cash_to_gross_p50":0.65,"medicare_rate":null,"medicare_schedule":null,"medicare_year":null,"cash_to_medicare_p50":null,"by_state":[{"state":"AK","n":18,"p20":300.35,"p50":349.05,"p80":617.0},{"state":"AL","n":40,"p20":97.42,"p50":147.15,"p80":417.0},{"state":"AR","n":32,"p20":92.3,"p50":125.45,"p80":171.95},{"state":"AZ","n":50,"p20":78.4,"p50":136.8,"p80":907.5},{"state":"CA","n":184,"p20":210.7,"p50":343.2,"p80":574.86},{"state":"CO","n":72,"p20":154.8,"p50":262.5,"p80":339.0},{"state":"CT","n":23,"p20":256.37,"p50":398.52,"p80":403.0},{"state":"DE","n":7,"p20":null,"p50":null,"p80":null},{"state":"FL","n":166,"p20":212.4,"p50":417.88,"p80":924.32},{"state":"GA","n":106,"p20":124.66,"p50":191.4,"p80":521.89},{"state":"HI","n":19,"p20":248.4,"p50":294.0,"p80":382.2},{"state":"IA","n":95,"p20":142.48,"p50":198.9,"p80":257.74},{"state":"ID","n":23,"p20":187.85,"p50":243.0,"p80":274.93},{"state":"IL","n":140,"p20":133.98,"p50":265.1,"p80":404.0},{"state":"IN","n":96,"p20":119.38,"p50":181.8,"p80":263.2},{"state":"KS","n":84,"p20":114.4,"p50":167.0,"p80":240.0},{"state":"KY","n":69,"p20":158.1,"p50":228.86,"p80":334.69},{"state":"LA","n":51,"p20":92.0,"p50":154.2,"p80":221.5},{"state":"MA","n":50,"p20":248.25,"p50":367.0,"p80":462.3},{"state":"MD","n":42,"p20":99.41,"p50":141.99,"p80":180.72},{"state":"ME","n":28,"p20":131.56,"p50":234.0,"p80":344.15},{"state":"MI","n":97,"p20":136.7,"p50":230.0,"p80":297.0},{"state":"MN","n":109,"p20":160.5,"p50":218.47,"p80":280.8},{"state":"MO","n":82,"p20":105.3,"p50":175.8,"p80":228.2},{"state":"MS","n":58,"p20":90.71,"p50":123.75,"p80":201.94},{"state":"MT","n":32,"p20":163.8,"p50":201.4,"p80":279.0},{"state":"NC","n":94,"p20":155.0,"p50":214.8,"p80":290.0},{"state":"ND","n":27,"p20":208.8,"p50":306.4,"p80":390.0},{"state":"NE","n":83,"p20":150.0,"p50":207.0,"p80":262.25},{"state":"NH","n":24,"p20":99.76,"p50":206.45,"p80":419.0},{"state":"NJ","n":45,"p20":118.76,"p50":128.99,"p80":413.97},{"state":"NM","n":29,"p20":160.02,"p50":246.4,"p80":361.2},{"state":"NV","n":21,"p20":144.95,"p50":266.0,"p80":380.0},{"state":"NY","n":98,"p20":112.9,"p50":198.04,"p80":422.0},{"state":"OH","n":142,"p20":176.0,"p50":274.3,"p80":405.0},{"state":"OK","n":63,"p20":101.46,"p50":132.6,"p80":208.0},{"state":"OR","n":55,"p20":195.04,"p50":248.0,"p80":332.0},{"state":"PA","n":125,"p20":156.6,"p50":281.4,"p80":530.4},{"state":"RI","n":10,"p20":92.4,"p50":256.37,"p80":560.0},{"state":"SC","n":53,"p20":155.35,"p50":279.03,"p80":463.8},{"state":"SD","n":43,"p20":260.58,"p50":295.2,"p80":380.0},{"state":"TN","n":80,"p20":75.45,"p50":129.6,"p80":222.76},{"state":"TX","n":222,"p20":165.06,"p50":322.4,"p80":463.5},{"state":"UT","n":40,"p20":158.5,"p50":351.43,"p80":439.29},{"state":"VA","n":73,"p20":126.0,"p50":261.0,"p80":364.8},{"state":"VT","n":14,"p20":247.28,"p50":288.0,"p80":432.0},{"state":"WA","n":67,"p20":160.3,"p50":234.0,"p80":331.0},{"state":"WI","n":102,"p20":182.6,"p50":242.25,"p80":294.75},{"state":"WV","n":38,"p20":128.37,"p50":198.25,"p80":315.0},{"state":"WY","n":16,"p20":147.63,"p50":198.03,"p80":338.99}],"by_segment":{"hospital_type":[{"key":"acute","n":2313,"p20":127.4,"p50":234.5,"p80":414.75},{"key":"childrens","n":73,"p20":219.84,"p50":366.6,"p80":549.5},{"key":"critical_access","n":941,"p20":152.0,"p50":224.25,"p80":320.25}],"ownership":[{"key":"for_profit","n":462,"p20":142.25,"p50":308.0,"p80":789.0},{"key":"government","n":619,"p20":135.0,"p50":211.5,"p80":315.21},{"key":"nonprofit","n":2246,"p20":135.42,"p50":230.0,"p80":366.0}],"affiliation":[{"key":"affiliated","n":2711,"p20":135.96,"p50":238.14,"p80":391.3},{"key":"independent","n":626,"p20":135.28,"p50":210.8,"p80":333.4}]},"histogram":[{"lo":86.1,"hi":106.81,"n":199},{"lo":106.81,"hi":132.5,"n":271},{"lo":132.5,"hi":164.36,"n":324},{"lo":164.36,"hi":203.89,"n":447},{"lo":203.89,"hi":252.93,"n":475},{"lo":252.93,"hi":313.76,"n":428},{"lo":313.76,"hi":389.22,"n":393},{"lo":389.22,"hi":482.83,"n":236},{"lo":482.83,"hi":598.95,"n":148},{"lo":598.95,"hi":743.0,"n":84}],"previous":null},"inpatient":{"setting":"inpatient","computed_at":"2026-09-25T11:55:12.319193Z","corpus_loaded_through":"2026-09-25T10:46:50.712029Z","filing_date_min":"2023-11-06","filing_date_max":"2026-09-22","checked_from":"2026-09-05T02:07:09.005325Z","checked_through":"2026-09-25T10:46:52.415798Z","n_priced_setters":3956,"n_filed":2422,"n_usable":2289,"n_not_usable":0,"n_labelled":24,"n_no_cash":109,"n_estimated":0,"n_states":50,"cash_p10":105.89,"cash_p20":143.5,"cash_p25":159.38,"cash_p50":240.0,"cash_p75":346.0,"cash_p80":373.45,"cash_p90":494.12,"cash_mean_trimmed":245.13,"gross_p50":397.0,"cash_to_gross_p50":0.6,"medicare_rate":null,"medicare_schedule":null,"medicare_year":null,"cash_to_medicare_p50":null,"by_state":[{"state":"AK","n":6,"p20":null,"p50":null,"p80":null},{"state":"AL","n":27,"p20":119.49,"p50":260.0,"p80":499.79},{"state":"AR","n":9,"p20":null,"p50":null,"p80":null},{"state":"AZ","n":46,"p20":86.32,"p50":136.8,"p80":907.5},{"state":"CA","n":145,"p20":235.8,"p50":360.57,"p80":624.0},{"state":"CO","n":49,"p20":152.1,"p50":262.5,"p80":339.0},{"state":"CT","n":11,"p20":194.7,"p50":368.5,"p80":420.2},{"state":"DE","n":6,"p20":null,"p50":null,"p80":null},{"state":"FL","n":100,"p20":152.0,"p50":317.85,"p80":531.12},{"state":"GA","n":82,"p20":125.0,"p50":186.75,"p80":306.0},{"state":"HI","n":14,"p20":248.4,"p50":271.2,"p80":382.2},{"state":"IA","n":54,"p20":153.6,"p50":200.7,"p80":264.55},{"state":"ID","n":13,"p20":199.0,"p50":253.0,"p80":351.43},{"state":"IL","n":107,"p20":131.42,"p50":265.1,"p80":415.1},{"state":"IN","n":80,"p20":117.91,"p50":179.5,"p80":247.1},{"state":"KS","n":29,"p20":105.58,"p50":168.0,"p80":261.0},{"state":"KY","n":43,"p20":150.41,"p50":207.9,"p80":283.2},{"state":"LA","n":32,"p20":92.0,"p50":150.72,"p80":211.97},{"state":"MA","n":43,"p20":248.25,"p50":375.0,"p80":476.66},{"state":"MD","n":34,"p20":91.18,"p50":120.97,"p80":159.84},{"state":"ME","n":22,"p20":131.56,"p50":234.0,"p80":371.1},{"state":"MI","n":76,"p20":158.6,"p50":230.0,"p80":297.0},{"state":"MN","n":90,"p20":159.62,"p50":211.65,"p80":280.0},{"state":"MO","n":45,"p20":157.3,"p50":186.89,"p80":219.84},{"state":"MS","n":38,"p20":94.0,"p50":178.49,"p80":287.7},{"state":"MT","n":20,"p20":146.4,"p50":192.0,"p80":279.0},{"state":"NC","n":47,"p20":192.5,"p50":244.16,"p80":290.0},{"state":"ND","n":19,"p20":195.16,"p50":294.4,"p80":329.0},{"state":"NE","n":31,"p20":107.28,"p50":225.7,"p80":286.0},{"state":"NH","n":14,"p20":135.42,"p50":206.45,"p80":342.0},{"state":"NJ","n":25,"p20":124.23,"p50":128.99,"p80":413.97},{"state":"NM","n":21,"p20":218.4,"p50":258.03,"p80":361.2},{"state":"NV","n":10,"p20":144.95,"p50":196.0,"p80":354.0},{"state":"NY","n":54,"p20":146.0,"p50":255.04,"p80":504.0},{"state":"OH","n":125,"p20":187.85,"p50":285.75,"p80":423.0},{"state":"OK","n":42,"p20":101.46,"p50":112.2,"p80":202.3},{"state":"OR","n":29,"p20":195.04,"p50":242.65,"p80":318.0},{"state":"PA","n":113,"p20":168.0,"p50":299.4,"p80":530.58},{"state":"RI","n":5,"p20":null,"p50":null,"p80":null},{"state":"SC","n":42,"p20":155.35,"p50":279.03,"p80":360.75},{"state":"SD","n":35,"p20":247.5,"p50":326.51,"p80":383.4},{"state":"TN","n":60,"p20":75.45,"p50":112.53,"p80":162.11},{"state":"TX","n":156,"p20":178.0,"p50":322.4,"p80":400.0},{"state":"UT","n":28,"p20":189.9,"p50":351.43,"p80":439.29},{"state":"VA","n":50,"p20":112.8,"p50":217.5,"p80":263.5},{"state":"VT","n":9,"p20":null,"p50":null,"p80":null},{"state":"WA","n":43,"p20":158.8,"p50":216.4,"p80":324.36},{"state":"WI","n":85,"p20":198.55,"p50":249.9,"p80":295.9},{"state":"WV","n":17,"p20":118.5,"p50":209.0,"p80":357.7},{"state":"WY","n":8,"p20":null,"p50":null,"p80":null}],"by_segment":{"hospital_type":[{"key":"acute","n":1682,"p20":134.29,"p50":240.0,"p80":389.25},{"key":"childrens","n":45,"p20":193.29,"p50":339.35,"p80":460.0},{"key":"critical_access","n":553,"p20":161.4,"p50":236.4,"p80":342.9}],"ownership":[{"key":"for_profit","n":251,"p20":132.23,"p50":257.56,"p80":463.5},{"key":"government","n":341,"p20":139.5,"p50":226.4,"p80":324.5},{"key":"nonprofit","n":1688,"p20":147.55,"p50":240.35,"p80":369.0}],"affiliation":[{"key":"affiliated","n":1936,"p20":147.94,"p50":243.6,"p80":378.8},{"key":"independent","n":353,"p20":131.76,"p50":210.06,"p80":339.0}]},"histogram":[{"lo":86.74,"hi":105.66,"n":114},{"lo":105.66,"hi":128.71,"n":149},{"lo":128.71,"hi":156.79,"n":174},{"lo":156.79,"hi":190.99,"n":251},{"lo":190.99,"hi":232.65,"n":296},{"lo":232.65,"hi":283.4,"n":331},{"lo":283.4,"hi":345.22,"n":282},{"lo":345.22,"hi":420.52,"n":235},{"lo":420.52,"hi":512.26,"n":131},{"lo":512.26,"hi":624.0,"n":111}],"previous":null}},"related":[{"code_type":"CPT","code":"97162","lay_name":"Physical therapy evaluation, moderate complexity","slug":"cpt-97162-physical-therapy-evaluation-moderate-complexity"},{"code_type":"CPT","code":"97161","lay_name":"Physical therapy evaluation, low complexity","slug":"cpt-97161-physical-therapy-evaluation-low-complexity"},{"code_type":"CPT","code":"97163","lay_name":"Physical therapy evaluation, high complexity","slug":"cpt-97163-physical-therapy-evaluation-high-complexity"},{"code_type":"CPT","code":"97164","lay_name":"Physical therapy re-evaluation","slug":"cpt-97164-physical-therapy-re-evaluation"},{"code_type":"CPT","code":"97165","lay_name":"Occupational therapy evaluation, low complexity","slug":"cpt-97165-occupational-therapy-evaluation-low-complexity"},{"code_type":"CPT","code":"92523","lay_name":"Speech sound and language evaluation","slug":"cpt-92523-speech-sound-and-language-evaluation"},{"code_type":"CPT","code":"97167","lay_name":"Occupational therapy evaluation, high complexity","slug":"cpt-97167-occupational-therapy-evaluation-high-complexity"},{"code_type":"CPT","code":"97168","lay_name":"Occupational therapy re-evaluation","slug":"cpt-97168-occupational-therapy-re-evaluation"},{"code_type":"CPT","code":"92522","lay_name":"Evaluation of speech sound production","slug":"cpt-92522-evaluation-of-speech-sound-production"},{"code_type":"CPT","code":"92521","lay_name":"Evaluation of speech fluency, such as stuttering","slug":"cpt-92521-evaluation-of-speech-fluency-such-as-stuttering"},{"code_type":"CPT","code":"97750","lay_name":"Physical performance testing, each 15 minutes","slug":"cpt-97750-physical-performance-testing-each-15-minutes"},{"code_type":"CPT","code":"96105","lay_name":"Language and speech loss testing, per hour","slug":"cpt-96105-language-and-speech-loss-testing-per-hour"}]}