97167
OT evaluation, high complexity
OT evaluation, high complexity is the #1,431 most-billed Medicaid procedure code, with $23.5M in payments across 327K claims from 2018–2024. The national median cost per claim is $70.96. Costs vary widely — the 90th percentile is $143.09 per claim, 2.0× the median.
Total Paid
$23.5M
0.00% of all spending
Total Claims
327K
Providers
855
Avg Cost/Claim
$72
National Cost Distribution
How much do providers bill per claim for 97167? Based on 813 providers billing this code nationally.
Median
$70.96
Average
$86.82
Std Dev
$68.13
Max
$997.00
Percentile Distribution (Cost per Claim)
50% of providers bill between $48.18 and $116.55 per claim for this code.
90% bill between $24.98 and $143.09.
Top 1% bill above $349.84.
About This Procedure
HCPCS code 97167 (OT evaluation, high complexity) was billed by 855 providers across 327K claims, totaling $23.5M in Medicaid payments from 2018–2024. This code was used for 253K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$70.96
Providers Billing
813
National Spending
$23.5M
Avg/Median Ratio
1.22×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for 97167
| # | Provider | Total Paid |
|---|---|---|
| 1 | Los Angeles Unified School District Los Angeles, CA · Social Worker School | $1.6M |
| 2 | Ahava Medical And Rehabilitation Center, Llc Brooklyn, NY · Rehabilitation Practitioner | $1.2M |
| 3 | Rector & Visitors Of The University Of Virginia Charlottesville, VA · General Acute Care Hospital | $1.1M |
| 4 | 1588709869 | $756K |
| 5 | Bilinguals Inc. Forest Hills, NY · Early Intervention Provider Agency | $723K |
| 6 | Nationwide Children's Hospital Columbus, OH · General Acute Care Hospital | $663K |
| 7 | 1780600825 | $661K |
| 8 | 1740338011 | $570K |
| 9 | Virginia Commonwealth University Health System Authority Richmond, VA · General Acute Care Hospital | $415K |
| 10 | 1265676092 | $379K |
| 11 | 1558418392 | $366K |
| 12 | 1134277320 | $348K |
| 13 | 1912166075 | $304K |
| 14 | 1427172782 | $287K |
| 15 | 1629280128 | $274K |
| 16 | 1851476931 | $239K |
| 17 | Therapy Management Services, Llc. Dallas, TX · Case Management | $234K |
| 18 | 1639395346 | $234K |
| 19 | Variety Children's Hospital Miami, FL · General Acute Care Hospital Children | $224K |
| 20 | 1306994470 | $219K |
Showing top 20 of 855 providers billing this code