CPT 97167 reports a high-complexity occupational therapy evaluation, typically about 60 minutes, with an unpredictable history and four or more personal factors.
When to use 97167
Use 97167 for an initial OT evaluation of high complexity. Low- and moderate-complexity initial evaluations use 97165 and 97166, and re-evaluation uses 97168.
How to bill it
Select 97167 for a high-complexity initial occupational therapy eval with an unpredictable history and four or more personal factors; report one unit per evaluation.
Common pitfalls
- Under-coding as moderate (97166) when the case met high-complexity criteria.
- Selecting the code by time rather than complexity.
Frequently asked questions
How is 97167 different from 97166?
97167 reflects high complexity with an unpredictable history and more personal factors; 97166 is moderate complexity.
How long is a 97167 evaluation?
A high-complexity OT eval is typically about 60 minutes, though complexity—not time—determines the code.