Price Checker / CPT 97166
CPT 97166 — Ot eval mod complex 45 min
2026 Medicare Physician Fee Schedule rates and hospital pricing data
$101
What Medicare pays in a hospital/ASC setting
$101
What Medicare pays in a physician's office
$1,680
Based on 47 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 97166
From hospital-published transparency (MRF) files. These are the hospitals in our database that list this procedure.
| Hospital | Gross Charge | Cash Rate | vs Medicare |
|---|---|---|---|
| Helen Keller Hospital , AL | $34,786 | $34,786 | 34499% |
| Rehabilitation Hospital of Rhode Island , RI | $6,123 | $6,123 | 5990% |
| UM Shore Medical Center at Cambridge , MD | $1,826 | $1,789 | 1716% |
| UM Shore Medical Center at Cambridge , MD | $1,826 | — | 1716% |
| UM Upper Chesapeake Behavior Health Pavilion at Aberdeen , MD | $1,816 | $1,779 | 1706% |
| UM Upper Chesapeake Behavior Health Pavilion at Aberdeen , MD | $1,816 | — | 1706% |
| HealthSource Saginaw , MI | — | — | 1690% |
| HealthSource Saginaw , MI | — | — | 1690% |
| UM Shore Medical Center at Easton , MD | $1,784 | $1,749 | 1675% |
| UM Capital Region Medical Center Largo, MD | $1,530 | — | 1421% |
| UM Capital Region Medical Center , MD | $1,530 | $1,499 | 1421% |
| UM Rehabilitation & Orthopaedic Institute Baltimore, MD | $1,220 | — | 1114% |
| UM Rehabilitation & Orthopaedic Institute , MD | $1,220 | $1,196 | 1114% |
| UM Upper Chesapeake Medical Center Bel Air, MD | $1,113 | — | 1007% |
| UM Upper Chesapeake Medical Center , MD | $1,113 | $1,090 | 1007% |
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About CPT 97166
CPT code 97166 refers to “Ot eval mod complex 45 min”. Under the 2026 Medicare Physician Fee Schedule, this procedure is reimbursed at $101 in a facility (hospital or ambulatory surgery center) and $101in 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.