97163 Pt evaluation high complex 45 minutes
Also known as: PT eval high complex, Comprehensive PT eval, Complex PT eval, physical therapy evaluation high, PT eval complex
Physical therapy evaluation of high complexity requiring 45 minutes. For patients with multiple conditions, significant medical history, or complex functional deficits.
In Plain Language
Physical therapy initial evaluation - complex case
Clinical Context
Used for medically complex patients with multiple comorbidities or complex functional impairments. Comprehensive baseline documentation.
RVU Breakdown
| Work RVU | 1.54 |
| Total RVU | 1.54 |
Est. Medicare Payment
National estimate based on 2026 CMS PFS Conversion Factor ($33.40). Actual payment varies by locality (GPCI adjustment).
Billing & Documentation
Medicine section codes cover a wide range of non-surgical services. Documentation should include the clinical indication, procedure details, interpretation (if applicable), and any patient-specific findings.
How This Code Compares
With a work RVU of 1.54, this code ranks in the 71st percentile among Medicine codes — 2.0x the median (0.78). The highest wRVU in this category is 23.92.
Specialties
Frequently Asked Questions
What is CPT code 97163?
CPT 97163 (Pt evaluation high complex 45 minutes) is a Medicine code. Physical therapy evaluation of high complexity requiring 45 minutes. For patients with multiple conditions, significant medical history, or complex functional deficits.
Who uses CPT code 97163?
CPT 97163 is used by Physical Therapy, Rehabilitation. Used for medically complex patients with multiple comorbidities or complex functional impairments. Comprehensive baseline documentation.
When is CPT 97163 used?
Used for medically complex patients with multiple comorbidities or complex functional impairments. Comprehensive baseline documentation.
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CPT® is a registered trademark of the American Medical Association. Data sourced from CMS Physician Fee Schedule RVU26A. Descriptions, synonyms, and clinical context are original content by RVU Edge.