97167 Ot evaluation high complex 60 minutes
Also known as: OT eval high complex, Comprehensive OT eval, Complex OT eval
Occupational therapy evaluation of high complexity requiring 60 minutes. Comprehensive evaluation for patients with multiple functional limitations.
In Plain Language
Occupational therapy initial evaluation - complex case
Clinical Context
Used for medically complex patients with multiple occupational performance deficits. Thorough 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 97167?
CPT 97167 (Ot evaluation high complex 60 minutes) is a Medicine code. Occupational therapy evaluation of high complexity requiring 60 minutes. Comprehensive evaluation for patients with multiple functional limitations.
Who uses CPT code 97167?
CPT 97167 is used by Occupational Therapy, Rehabilitation. Used for medically complex patients with multiple occupational performance deficits. Thorough baseline documentation.
When is CPT 97167 used?
Used for medically complex patients with multiple occupational performance deficits. Thorough 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.