97165
OT evaluation, low complexity
OT evaluation, low complexity is the #969 most-billed Medicaid procedure code, with $52.6M in payments across 941K claims from 2018–2024. The national median cost per claim is $46.78. Costs vary widely — the 90th percentile is $104.86 per claim, 2.2× the median.
Total Paid
$52.6M
0.00% of all spending
Total Claims
941K
Providers
2K
Avg Cost/Claim
$56
National Cost Distribution
How much do providers bill per claim for 97165? Based on 2K providers billing this code nationally.
Median
$46.78
Average
$56.23
Std Dev
$49.59
Max
$544.12
Percentile Distribution (Cost per Claim)
50% of providers bill between $27.92 and $66.87 per claim for this code.
90% bill between $12.27 and $104.86.
Top 1% bill above $275.05.
About This Procedure
HCPCS code 97165 (OT evaluation, low complexity) was billed by 2K providers across 941K claims, totaling $52.6M in Medicaid payments from 2018–2024. This code was used for 809K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$46.78
Providers Billing
2K
National Spending
$52.6M
Avg/Median Ratio
1.20×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for 97165
| # | Provider | Total Paid |
|---|---|---|
| 1 | Children's Specialized Hospital New Brunswick, NJ · Pediatrics | $2.8M |
| 2 | Virginia Commonwealth University Health System Authority Richmond, VA · General Acute Care Hospital | $706K |
| 3 | Childrens Hospital Of The Kings Daughters Inc Norfolk, VA · Social Worker, Clinical | $696K |
| 4 | 1255354288 | $688K |
| 5 | 1912166075 | $665K |
| 6 | Dayton Children's Hospital Dayton, OH · General Acute Care Hospital, Children | $585K |
| 7 | District Hospital Partners L P Washington, DC · Nurse Practitioner, Family | $582K |
| 8 | Umass Memorial Medical Center, Inc. Worcester, MA · General Acute Care Hospital | $568K |
| 9 | Connecticut Children's Medical Center Hartford, CT · General Acute Care Hospital, Children | $552K |
| 10 | Scottish Rite Children's Medical Center Atlanta, GA · Pediatrics Pediatric Hematology-Oncology | $527K |
| 11 | Children's Hospital Medical Center Cincinnati, OH · Clinic/Center, Primary Care | $510K |
| 12 | New York Network Ipa Inc Brooklyn, NY · Exclusive Provider Organization | $498K |
| 13 | Boston Medical Center Corporation Boston, MA · General Acute Care Hospital | $450K |
| 14 | 1932343787 | $448K |
| 15 | Hartford Hospital Hartford, CT · General Acute Care Hospital | $425K |
| 16 | 1942861919 | $414K |
| 17 | Medstar Washington Hospital Center Washington, DC · General Acute Care Hospital | $408K |
| 18 | Johns Hopkins All Children's Hospital Inc St Petersburg, FL · General Acute Care Hospital Children | $377K |
| 19 | 1669578324 | $370K |
| 20 | 1467506691 | $370K |
Showing top 20 of 2K providers billing this code