#1607 of 11K

97168

OT re-evaluation

OT re-evaluation is the #1,607 most-billed Medicaid procedure code, with $17.9M in payments across 279K claims from 2018–2024. The national median cost per claim is $50.43. Costs vary widely — the 90th percentile is $108.13 per claim, 2.1× the median.

Total Paid

$17.9M

0.00% of all spending

Total Claims

279K

Providers

957

Avg Cost/Claim

$64

National Cost Distribution

How much do providers bill per claim for 97168? Based on 925 providers billing this code nationally.

Median

$50.43

Average

$66.66

Std Dev

$79.09

Max

$1,927.65

Percentile Distribution (Cost per Claim)

p10

$20.83

p25

$33.38

Median

$50.43

p75

$89.82

p90

$108.13

p95

$159.98

p99

$249.78

50% of providers bill between $33.38 and $89.82 per claim for this code.

90% bill between $20.83 and $108.13.

Top 1% bill above $249.78.

About This Procedure

HCPCS code 97168 (OT re-evaluation) was billed by 957 providers across 279K claims, totaling $17.9M in Medicaid payments from 2018–2024. This code was used for 255K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$50.43

Providers Billing

925

National Spending

$17.9M

Avg/Median Ratio

1.32×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 97168

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Ahava Medical And Rehabilitation Center, Llc Brooklyn, NY · Rehabilitation Practitioner	$974K	$82.18	1.6× median	Above Median
2	Dcps - Public Schools Washington, DC · Local Education Agency (LEA)	$740K	$1,927.65	38.2× median	Top 1%
3	Variety Children's Hospital Miami, FL · General Acute Care Hospital Children	$642K	$336.34	6.7× median	Top 1%
4	1134152861	$580K	$24.70	0.5× median	Below Median
5	1790085934	$394K	$94.73	1.9× median	Above 75th
6	Los Angeles Unified School District Los Angeles, CA · Social Worker School	$372K	$96.70	1.9× median	Above 75th
7	Children's Specialized Hospital New Brunswick, NJ · Pediatrics	$311K	$292.32	5.8× median	Top 1%
8	1659485936	$290K	$36.75	0.7× median	Below Median
9	1033510821	$255K	$91.23	1.8× median	Above 75th
10	1134371651	$248K	$99.72	2.0× median	Above 75th
11	1972727816	$238K	$200.15	4.0× median	Top 10%
12	Children's Hospital Medical Center Cincinnati, OH · Clinic/Center, Primary Care	$234K	$98.77	2.0× median	Above 75th
13	1801009188	$227K	$97.63	1.9× median	Above 75th
14	1033527650	$220K	$98.85	2.0× median	Above 75th
15	1386988723	$206K	$51.11	1.0× median	Above Median
16	Therapy Management Services, Llc. Dallas, TX · Case Management	$205K	$95.53	1.9× median	Above 75th
17	1619051083	$202K	$76.48	1.5× median	Above Median
18	1497897292	$182K	$94.86	1.9× median	Above 75th
19	1073788048	$180K	$90.46	1.8× median	Above 75th
20	1225076904	$177K	$98.84	2.0× median	Above 75th

Showing top 20 of 957 providers billing this code

Related Procedures

97161Physical therapy evaluation, low complexity$244.8M 97162PT evaluation, moderate complexity$170.3M 97165OT evaluation, low complexity$52.6M 97163PT evaluation, high complexity$41.2M 97166OT evaluation, moderate complexity$40.4M

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