CPT 97166 Physical Therapy/Rehab
Ot eval mod complex 45 min Cost
Body System: Musculoskeletal
Medicare Facility Rate
$101
CMS PFS CY2026
Medicare Non-Facility Rate
$101
Office/clinic setting
Relative Value Units (RVUs)
Medicare payment = Total RVU × Conversion Factor ($33.40 for CY 2026)
1.54
Work RVU
1.46
Facility PE RVU
0.01
Malpractice RVU
3.01
Total RVU
Frequently Asked Questions
How much does Ot eval mod complex 45 min cost?
The Medicare facility rate is $101. Commercial insurance typically pays 150-250% of Medicare rates (varies).
How much does Ot eval mod complex 45 min cost without insurance?
Without insurance, you may pay the hospital's chargemaster rate, which is often 300-500% of Medicare. Ask about cash-pay discounts — many facilities offer 20-40% off for self-pay patients. The Medicare baseline for this procedure is $101.