97161
Physical therapy evaluation, low complexity
Physical therapy evaluation, low complexity is the #423 most-billed Medicaid procedure code, with $244.8M in payments across 4.5M claims from 2018–2024. The national median cost per claim is $47.89. Costs vary widely — the 90th percentile is $98.83 per claim, 2.1× the median.
Total Paid
$244.8M
0.02% of all spending
Total Claims
4.5M
Providers
5K
Avg Cost/Claim
$55
National Cost Distribution
How much do providers bill per claim for 97161? Based on 5K providers billing this code nationally.
Median
$47.89
Average
$57.07
Std Dev
$49.78
Max
$798.33
Percentile Distribution (Cost per Claim)
50% of providers bill between $32.64 and $65.45 per claim for this code.
90% bill between $15.42 and $98.83.
Top 1% bill above $265.64.
About This Procedure
HCPCS code 97161 (Physical therapy evaluation, low complexity) was billed by 5K providers across 4.5M claims, totaling $244.8M in Medicaid payments from 2018–2024. This code was used for 4.1M unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$47.89
Providers Billing
5K
National Spending
$244.8M
Avg/Median Ratio
1.19×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for 97161
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1952394603 | $4.2M |
| 2 | Scottish Rite Children's Medical Center Atlanta, GA · Pediatrics Pediatric Hematology-Oncology | $3.3M |
| 3 | 1255354288 | $2.6M |
| 4 | Virginia Commonwealth University Health System Authority Richmond, VA · General Acute Care Hospital | $2.2M |
| 5 | Children's Specialized Hospital New Brunswick, NJ · Pediatrics | $2.1M |
| 6 | Hartford Hospital Hartford, CT · General Acute Care Hospital | $1.9M |
| 7 | District Hospital Partners L P Washington, DC · Nurse Practitioner, Family | $1.8M |
| 8 | Boston Medical Center Corporation Boston, MA · General Acute Care Hospital | $1.7M |
| 9 | 1770540593 | $1.6M |
| 10 | 1811084676 | $1.6M |
| 11 | Nyu Langone Hospitals New York, NY · Clinic/Center, Oncology | $1.5M |
| 12 | University Of Rochester Rochester, NY · General Acute Care Hospital | $1.4M |
| 13 | New York Network Ipa Inc Brooklyn, NY · Exclusive Provider Organization | $1.3M |
| 14 | Riverside Hospital Inc Newport News, VA · Psychiatric Hospital | $1.2M |
| 15 | Adventist Health System-sunbelt, Inc Orlando, FL · Ambulance, Land Transport | $1.2M |
| 16 | Childrens Hospital Of The Kings Daughters Inc Norfolk, VA · Social Worker, Clinical | $1.2M |
| 17 | Children's Hospital Medical Center Cincinnati, OH · Clinic/Center, Primary Care | $1.1M |
| 18 | Baystate Medical Center Inc Springfield, MA · General Acute Care Hospital | $1.1M |
| 19 | Brockton Hospital, Inc. Brockton, MA · General Acute Care Hospital | $1.1M |
| 20 | 1336187475 | $1.1M |
Showing top 20 of 5K providers billing this code