Price Checker / CPT 97162
CPT 97162 — Pt eval mod complex 30 min
2026 Medicare Physician Fee Schedule rates and hospital pricing data
$98
What Medicare pays in a hospital/ASC setting
$98
What Medicare pays in a physician's office
$2,678
Based on 73 hospital(s) in our database
What do these numbers mean?
The Medicare rateis what the federal government determines is a fair payment for this procedure. It's based on the Relative Value Unit (RVU) system, which accounts for physician work, practice expense, and malpractice cost. Hospitals and providers often charge 3-20x this amount. If your bill is significantly higher than the Medicare rate, you may have grounds to negotiate.
Hospital Charges for CPT 97162
From hospital-published transparency (MRF) files. These are the hospitals in our database that list this procedure.
| Hospital | Gross Charge | Cash Rate | vs Medicare |
|---|---|---|---|
| South Shore University Hospital , NY | — | $367 | 25943% |
| Phelps Hospital , NY | — | $367 | 25898% |
| Oklahoma Heart Hospital , OK | — | $8,620 | 22549% |
| Oklahoma Heart Hospital South , OK | — | $8,620 | 22549% |
| Northern Westchester Hospital , NY | — | $367 | 17812% |
| Decatur Morgan Hospital , AL | $10,885 | $10,885 | 11023% |
| Springhill Medical Center , AL | $8,529 | $8,529 | 8615% |
| UM Capital Region Medical Center Largo, MD | $3,216 | — | 3186% |
| UM Capital Region Medical Center , MD | $3,216 | $3,152 | 3186% |
| University of Maryland Medical Center Baltimore, MD | $3,094 | — | 3062% |
| University of Maryland Medical Center , MD | $3,094 | $3,033 | 3062% |
| Wyoming County Community Health System , NY | $200 | — | 2454% |
| UM Shore Medical Center at Easton Easton, MD | $2,497 | — | 2452% |
| UM Shore Medical Center at Easton , MD | $2,497 | $2,447 | 2452% |
| UM Upper Chesapeake Behavior Health Pavilion at Aberdeen , MD | $1,957 | $1,918 | 1900% |
Were you billed for this procedure?
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About CPT 97162
CPT code 97162 refers to “Pt eval mod complex 30 min”. Under the 2026 Medicare Physician Fee Schedule, this procedure is reimbursed at $98 in a facility (hospital or ambulatory surgery center) and $98in a non-facility (physician's office) setting.
These rates are set by CMS (Centers for Medicare & Medicaid Services) and represent what the government considers a fair payment for this service. While commercial insurance typically pays somewhat more than Medicare, many hospitals charge significantly higher amounts — sometimes 10-50x the Medicare rate.
What to do if you were overcharged
- Upload your bill— we'll identify this code and compare it against the rates shown above.
- Get a dispute letter— citing the Medicare rate and your hospital's own published pricing data.
- Negotiate or let us handle it — 25% of savings, no savings = no fee.