CPT 97161: Physical Therapy Evaluation, Low Complexity
CPT 97161 reports a low-complexity physical therapy evaluation — a stable presentation with a limited history and 1-2 elements examined, typically about 20 minutes. It is an untimed code billed once per evaluation. In 2026 Medicare pays about $97.86 non-facility (national, before locality adjustment).
- Code type
- PT evaluation (untimed, one per eval)
- 2026 Medicare
- ~$97.86 (non-facility)
- Timed?
- No — billed once, not per 15 min
- Therapy cap
- Counts toward 2026 KX threshold ($2,480 PT/SLP)
What is CPT 97161 used for?
CPT 97161 is a low-complexity physical therapy evaluation, the code that opens a plan of care for a straightforward, stable patient. It is one of three PT evaluation tiers introduced in 2017 to replace the old single evaluation code, and it is untimed — billed once per initial evaluation, not per 15 minutes.
You select the tier by matching three components — history, examination, and clinical decision making — to the level. 97161 applies when all three land at the low end.
What are the three PT evaluation tiers?
| Code | Complexity | Typical time |
|---|---|---|
| 97161 | Low | ~20 minutes |
| 97162 | Moderate | ~30 minutes |
| 97163 | High | ~45 minutes |
Low complexity means no comorbidities affecting the plan, 1-2 examined elements, and a stable presentation. Moderate adds one or more comorbidities and 3+ examined elements with an evolving presentation; high involves multiple comorbidities and an unstable presentation.
How much does 97161 pay in 2026?
All three PT evaluation tiers are paid at the same Medicare rate — about $97.86 non-facility in 2026 before locality adjustment. Picking the higher tier does not raise the payment, so code the tier your documentation actually supports rather than reaching. Run your locality figure through the Medicare fee calculator.
How do you choose the right evaluation level?
All three components must reach a tier to bill it. If history is moderate but examination and decision making are low, the evaluation is low complexity. The evaluation counts toward the 2026 KX threshold of $2,480 for combined PT and SLP, and it sets the medical necessity foundation for every timed code that follows — 97110, 97140, 97112, and 97530. For occupational therapy, the parallel evaluation code is 97165.
Frequently asked questions
97161 fits a stable patient with a low-complexity presentation: a history with no personal factors or comorbidities affecting care, an examination addressing 1-2 elements, and clinical decision making of low complexity with a stable presentation. Typical face-to-face time is about 20 minutes. All components must meet the low tier.
No. The three PT evaluation codes are untimed — you bill one evaluation code per initial evaluation regardless of exact duration. The associated times (about 20, 30, and 45 minutes) are typical values, not billing thresholds, so the 8-minute rule does not apply.
The three PT evaluation tiers (97161, 97162, 97163) are all valued the same by Medicare, at about $97.86 non-facility in 2026 before locality adjustment. Medicare pays 80 percent after the deductible. The tier you pick does not change the payment, but it must match the documentation.
Sources & further reading
Reviewed by the ImmediCare Solutions RCM team
Certified billers and coders handling claims across 50+ specialties nationwide. This entry is reviewed against current payer policy and CMS rules. Last review: Jul 5, 2026.
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