CPT 97165 reports a low-complexity occupational therapy evaluation, typically about 30 minutes, with a stable history and one to two personal factors.
When to use 97165
Use 97165 for an initial OT evaluation of low complexity. Moderate- and high-complexity initial evaluations use 97166 and 97167, and re-evaluation uses 97168.
How to bill it
Select 97165 for a low-complexity initial occupational therapy eval with a stable history and one to two personal factors; report one unit per evaluation.
Common pitfalls
- Selecting the eval code by time rather than complexity.
- Confusing OT evaluations (97165–97168) with PT evaluations (97161–97164).
Frequently asked questions
How do I choose among 97165, 97166, and 97167?
Selection is based on the stability of the history and the number of personal factors. 97165 is low, 97166 moderate, and 97167 high complexity.
How is an OT eval different from a PT eval?
OT evaluations (97165–97168) focus on occupational performance and daily function; PT evaluations (97161–97164) focus on mobility and physical function.