Medicare rate for CPT 97163 in 2026

How the $97.86 is built

Work RVU 1.54, practice-expense RVU 1.38 in an office, malpractice RVU 0.01. Each is multiplied by its geographic index, added together, then multiplied by the 2026 conversion factor of $33.4009. With every index at 1.000 that gives $97.86 in an office.

CMS marks the facility (hospital) setting as Not Applicable for 97163, so there is no separate hospital rate.

This is the allowed amount for one unit, before the 2% sequestration reduction and before any multiple-procedure reduction. It is what Medicare allows, not what a commercial carrier or an auto policy allows, and not what the provider billed. Current Procedural Terminology (CPT) is copyright 2019–2025 American Medical Association (AMA). All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. CPT® is a trademark of the American Medical Association.

What CPT 97163 pays in New Jersey

New Jersey has 2 Medicare localities, so there is no single New Jersey rate. In an office the allowed amount runs from $104.20 to $108.50, a spread of 4.1% across the state.

CPT 97163 by fee-schedule year, 2023 to 2026

A bill is priced under the schedule in force on its date of service, not the one in force when it is reviewed. Note that 2024 has two entries: Congress changed the conversion factor on 9 March 2024, so a January 2024 date of service and a June 2024 date of service price differently.

National amounts, every geographic index at 1.000, so the year-to-year movement here is the fee schedule changing and not a change of location.

CPT 97163 in every state

The office allowed amount in each state, highest locality to lowest. Where a state shows one figure it has a single Medicare locality.

Checking a different code, state or year

The Medicare rate lookup prices all 17,000-plus codes in the Physician Fee Schedule for any state and any fee-schedule year from 2023 to 2026. Ambulance codes are priced separately on the ambulance fee schedule, because Medicare does not pay for ambulance transport under this schedule at all.

More in Physical medicine and rehabilitation

• CPT 97140National $27.72
• CPT 97150National $18.04
• CPT 97161National $97.86
• CPT 97162National $97.86
• CPT 97164National $67.47
• CPT 97165National $100.54
• CPT 97166National $100.54
• CPT 97167National $100.54

A single figure means the office and facility amounts are the same, or CMS prices the code in one setting only; the code’s own page says which. All 49 codes in this family, with their national amounts, are on the Physical medicine and rehabilitation page. See also the full list of code families and the CMS release catalog, which names the archived CMS files behind every figure.

Medicare rates are a benchmark, not an allowance. What a no-fault, workers’ compensation or commercial carrier owes for CPT 97163 is set by the fee schedule or policy that governs the claim, which is frequently a multiple of the figure above.