97163
PT evaluation, high complexity
PT evaluation, high complexity is the #1,095 most-billed Medicaid procedure code, with $41.2M in payments across 754K claims from 2018–2024. The national median cost per claim is $50.34. Costs vary widely — the 90th percentile is $120.52 per claim, 2.4× the median.
Total Paid
$41.2M
0.00% of all spending
Total Claims
754K
Providers
1K
Avg Cost/Claim
$55
National Cost Distribution
How much do providers bill per claim for 97163? Based on 1K providers billing this code nationally.
Median
$50.34
Average
$62.39
Std Dev
$48.46
Max
$427.00
Percentile Distribution (Cost per Claim)
50% of providers bill between $34.68 and $74.80 per claim for this code.
90% bill between $16.69 and $120.52.
Top 1% bill above $241.20.
About This Procedure
HCPCS code 97163 (PT evaluation, high complexity) was billed by 1K providers across 754K claims, totaling $41.2M in Medicaid payments from 2018–2024. This code was used for 641K unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$50.34
Providers Billing
1K
National Spending
$41.2M
Avg/Median Ratio
1.24×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for 97163
| # | Provider | Total Paid |
|---|---|---|
| 1 | Rector & Visitors Of The University Of Virginia Charlottesville, VA · General Acute Care Hospital | $1.8M |
| 2 | Ahava Medical And Rehabilitation Center, Llc Brooklyn, NY · Rehabilitation Practitioner | $1.7M |
| 3 | 1780600825 | $988K |
| 4 | Virginia Commonwealth University Health System Authority Richmond, VA · General Acute Care Hospital | $897K |
| 5 | 1669531166 | $824K |
| 6 | 1043563257 | $729K |
| 7 | 1194807941 | $718K |
| 8 | 1396781050 | $562K |
| 9 | 1871570309 | $539K |
| 10 | 1053301127 | $522K |
| 11 | 1902808470 | $491K |
| 12 | 1598708513 | $446K |
| 13 | 1861072340 | $427K |
| 14 | 1770830325 | $424K |
| 15 | 1114947058 | $418K |
| 16 | 1750559431 | $404K |
| 17 | 1912166075 | $383K |
| 18 | 1134277320 | $380K |
| 19 | 1902079452 | $367K |
| 20 | 1316940505 | $343K |
Showing top 20 of 1K providers billing this code