Price Checker / CPT 97163
CPT 97163 — Pt eval high complex 45 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
$1,400
Based on 75 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 97163
From hospital-published transparency (MRF) files. These are the hospitals in our database that list this procedure.
| Hospital | Gross Charge | Cash Rate | vs Medicare |
|---|---|---|---|
| Huntsville Hospital , AL | $33,386 | $33,386 | 34016% |
| Springhill Medical Center , AL | $4,721 | $4,721 | 4724% |
| 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% |
| 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% |
| UM Upper Chesapeake Behavior Health Pavilion at Aberdeen , MD | $1,957 | — | 1900% |
| UM Shore Medical Center at Chestertown Chestertown, MD | $1,874 | — | 1815% |
| UM Shore Medical Center at Chestertown , MD | $1,874 | $1,836 | 1815% |
| HealthSource Saginaw , MI | — | — | 1739% |
| HealthSource Saginaw , MI | — | — | 1739% |
| University of Maryland Medical Center - Midtown Campus , MD | $1,775 | $1,740 | 1714% |
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About CPT 97163
CPT code 97163 refers to “Pt eval high complex 45 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.