CPT 97166 reports a moderate-complexity occupational therapy evaluation, typically about 45 minutes, with an evolving history and three or more personal factors.
When to use 97166
Use 97166 for an initial OT evaluation of moderate complexity. Low- and high-complexity initial evaluations use 97165 and 97167, and re-evaluation uses 97168.
How to bill it
Select 97166 for a moderate-complexity initial occupational therapy eval with an evolving history and three or more personal factors; report one unit per evaluation.
Common pitfalls
- Defaulting to the middle code without assessing complexity factors.
- Confusing OT (97166) with PT (97162) moderate-complexity evaluations.
Frequently asked questions
How is 97166 different from 97165?
97166 reflects moderate complexity with an evolving history and more personal factors; 97165 is low complexity.
How long is a 97166 evaluation?
A moderate-complexity OT eval is typically about 45 minutes, though complexity drives code selection.