97166
OT evaluation, moderate complexity
OT evaluation, moderate complexity is the #1,108 most-billed Medicaid procedure code, with $40.4M in payments across 617K claims from 2018–2024. The national median cost per claim is $48.74. Costs vary widely — the 90th percentile is $117.65 per claim, 2.4× the median.
Total Paid
$40.4M
0.00% of all spending
Total Claims
617K
Providers
2K
Avg Cost/Claim
$65
National Cost Distribution
How much do providers bill per claim for 97166? Based on 2K providers billing this code nationally.
Median
$48.74
Average
$59.50
Std Dev
$62.82
Max
$1,540.04
Percentile Distribution (Cost per Claim)
50% of providers bill between $25.19 and $72.88 per claim for this code.
90% bill between $10.90 and $117.65.
Top 1% bill above $267.38.
About This Procedure
HCPCS code 97166 (OT evaluation, moderate complexity) was billed by 2K providers across 617K claims, totaling $40.4M in Medicaid payments from 2018–2024. This code was used for 538K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$48.74
Providers Billing
2K
National Spending
$40.4M
Avg/Median Ratio
1.22×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for 97166
| # | Provider | Total Paid |
|---|---|---|
| 1 | Children's Specialized Hospital New Brunswick, NJ · Pediatrics | $2.3M |
| 2 | 1285761031 | $2.1M |
| 3 | 1104279603 | $843K |
| 4 | 1407981053 | $738K |
| 5 | 1043455454 | $582K |
| 6 | 1780600825 | $575K |
| 7 | Children's Hospital Medical Center Cincinnati, OH · Clinic/Center, Primary Care | $496K |
| 8 | Virginia Commonwealth University Health System Authority Richmond, VA · General Acute Care Hospital | $495K |
| 9 | 1285793448 | $479K |
| 10 | Cleveland Clinic Children's Hospital For Rehabilitation Cleveland, OH · Rehabilitation Hospital Children | $477K |
| 11 | 1669736104 | $436K |
| 12 | Yale New Haven Hospital New Haven, CT · General Acute Care Hospital | $431K |
| 13 | Johns Hopkins All Children's Hospital Inc St Petersburg, FL · General Acute Care Hospital Children | $430K |
| 14 | 1659688158 | $422K |
| 15 | 1306240817 | $380K |
| 16 | Children's Hospital Medical Center Of Akron Akron, OH · General Acute Care Hospital Children | $371K |
| 17 | Phoenix Children's Hospital Phoenix, AZ · General Acute Care Hospital Children | $368K |
| 18 | District Hospital Partners L P Washington, DC · Nurse Practitioner, Family | $348K |
| 19 | Nationwide Children's Hospital Columbus, OH · General Acute Care Hospital | $340K |
| 20 | 1992142111 | $337K |
Showing top 20 of 2K providers billing this code