Medical Procedure
CPT Code 97165
Occupational therapy evaluation, low complexity
National Average Rate
$93.47
CMS non-facility rate
Data Source
CMS Medicare
Physician Fee Schedule 2024
What This Means for Your Bill
- Medicare pays $93.47 nationally for CPT 97165 in a non-facility (office) setting.
- Private insurers typically pay 110–140% of the Medicare rate, so a fair price is roughly $117–$131.
- If your bill shows a charge significantly above this, you may have grounds to negotiate or dispute it.
How to Use This Information
1
Find CPT 97165 on your itemized bill — hospitals are required to provide one on request.
2
Compare the charged amount to $93.47 — if your bill is 2× or more, that's a red flag.
3
Use our AI bill analyzer to scan your full bill, flag errors, and get a dispute letter in under 2 minutes.
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