97162
PT evaluation, moderate complexity
PT evaluation, moderate complexity is the #517 most-billed Medicaid procedure code, with $170.3M in payments across 3.2M claims from 2018–2024. The national median cost per claim is $46.10. Costs vary widely — the 90th percentile is $96.53 per claim, 2.1× the median.
Total Paid
$170.3M
0.02% of all spending
Total Claims
3.2M
Providers
5K
Avg Cost/Claim
$54
National Cost Distribution
How much do providers bill per claim for 97162? Based on 5K providers billing this code nationally.
Median
$46.10
Average
$53.37
Std Dev
$44.89
Max
$719.00
Percentile Distribution (Cost per Claim)
50% of providers bill between $29.22 and $63.70 per claim for this code.
90% bill between $13.39 and $96.53.
Top 1% bill above $246.31.
About This Procedure
HCPCS code 97162 (PT evaluation, moderate complexity) was billed by 5K providers across 3.2M claims, totaling $170.3M in Medicaid payments from 2018–2024. This code was used for 2.9M unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$46.10
Providers Billing
5K
National Spending
$170.3M
Avg/Median Ratio
1.16×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for 97162
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1780600825 | $3.2M |
| 2 | Scottish Rite Children's Medical Center Atlanta, GA · Pediatrics Pediatric Hematology-Oncology | $2.1M |
| 3 | 1104120385 | $1.7M |
| 4 | Yale New Haven Hospital New Haven, CT · General Acute Care Hospital | $1.6M |
| 5 | Virginia Commonwealth University Health System Authority Richmond, VA · General Acute Care Hospital | $1.6M |
| 6 | Bronxcare Health System Bronx, NY · General Acute Care Hospital | $1.4M |
| 7 | 1750399192 | $1.4M |
| 8 | New York Network Ipa Inc Brooklyn, NY · Exclusive Provider Organization | $1.3M |
| 9 | Riverside Hospital Inc Newport News, VA · Psychiatric Hospital | $1.1M |
| 10 | 1255354288 | $1.0M |
| 11 | 1487740957 | $1.0M |
| 12 | 1528061827 | $993K |
| 13 | 1871805150 | $984K |
| 14 | Beth Israel Medical Center Brooklyn, NY · Psychiatric Unit | $977K |
| 15 | 1073746533 | $949K |
| 16 | Hartford Hospital Hartford, CT · General Acute Care Hospital | $937K |
| 17 | Children's Specialized Hospital New Brunswick, NJ · Pediatrics | $932K |
| 18 | District Hospital Partners L P Washington, DC · Nurse Practitioner, Family | $897K |
| 19 | 1265489736 | $819K |
| 20 | Aurora Health Care Metro, Inc. Milwaukee, WI · Internal Medicine, Hematology & Oncology | $797K |
Showing top 20 of 5K providers billing this code