Price Checker / CPT 97168
CPT 97168 — Ot re-eval est plan care
2026 Medicare Physician Fee Schedule rates and hospital pricing data
$68
What Medicare pays in a hospital/ASC setting
$68
What Medicare pays in a physician's office
$543
Based on 36 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 97168
From hospital-published transparency (MRF) files. These are the hospitals in our database that list this procedure.
| Hospital | Gross Charge | Cash Rate | vs Medicare |
|---|---|---|---|
| Wyoming County Community Health System , NY | $129 | — | 3551% |
| HealthSource Saginaw , MI | — | — | 2529% |
| HealthSource Saginaw , MI | — | — | 2529% |
| UM Shore Medical Center at Cambridge , MD | $1,027 | $1,007 | 1400% |
| UM Shore Medical Center at Cambridge , MD | $1,027 | — | 1400% |
| UM Upper Chesapeake Behavior Health Pavilion at Aberdeen , MD | $1,021 | $1,001 | 1392% |
| UM Upper Chesapeake Behavior Health Pavilion at Aberdeen , MD | $1,021 | — | 1392% |
| UM Shore Medical Center at Easton , MD | $1,004 | $984 | 1366% |
| Penn State Health Rehabilitation Hospital , PA | $136 | — | 1309% |
| UM Capital Region Medical Center , MD | $860 | $843 | 1157% |
| UM Upper Chesapeake Medical Center Aberdeen Aberdeen, MD | $730 | — | 966% |
| UM Upper Chesapeake Medical Center Aberdeen , MD | $730 | $715 | 966% |
| UM Upper Chesapeake Medical Center , MD | $715 | $701 | 945% |
| Helen Hayes Hospital , NY | $645 | $645 | 842% |
| UM Charles Regional Medical Center , MD | $619 | $606 | 804% |
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About CPT 97168
CPT code 97168 refers to “Ot re-eval est plan care”. Under the 2026 Medicare Physician Fee Schedule, this procedure is reimbursed at $68 in a facility (hospital or ambulatory surgery center) and $68in 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.