Evaluation for occupational therapy, typically 45 minutes
Medicare pricing data for 10,505 providers across 51 states
Note: These costs reflect the Medicare physician/supplier component. Hospital facility fees are billed separately and can be 2-5x the physician fee.
💡 What You Should Know
Evaluation for occupational therapy, typically 45 minutes (HCPCS code 97166) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $100.64, but hospitals typically charge $181.44 — a 1.8x markup. Prices vary significantly by state and provider.
🏷️ Typical Out-of-Pocket Cost
Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $100.64, your out-of-pocket cost would be approximately $20.13. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.
What Hospitals Charge vs. What Medicare Pays
Hospitals charge 1.8x more than what Medicare allows for this procedure. Medicare actually pays $76.75 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Alaska | $117 | $208 | 31 | 251 | +16.6% |
| District of Columbia | $111 | $196 | 20 | 394 | +10.5% |
| New York | $111 | $181 | 980 | 18,054 | +10.3% |
| California | $108 | $192 | 684 | 13,857 | +7.2% |
| New Jersey | $107 | $186 | 837 | 14,402 | +6.0% |
| Connecticut | $106 | $162 | 123 | 1,664 | +5.8% |
| Massachusetts | $105 | $197 | 185 | 3,028 | +4.2% |
| Maryland | $104 | $161 | 264 | 4,562 | +3.8% |
| Rhode Island | $103 | $154 | 31 | 401 | +2.1% |
| Washington | $103 | $195 | 261 | 2,933 | +2.1% |
| Virginia | $101 | $159 | 248 | 3,502 | +0.3% |
| Delaware | $101 | $165 | 54 | 970 | +0.1% |
| New Hampshire | $101 | $189 | 47 | 625 | +0.1% |
| Colorado | $101 | $179 | 259 | 2,700 | +0.0% |
| Montana | $99 | $177 | 37 | 711 | -1.4% |
| Vermont | $99 | $173 | 10 | 78 | -1.6% |
| Pennsylvania | $99 | $162 | 467 | 8,120 | -1.7% |
| Nevada | $99 | $191 | 88 | 1,115 | -2.0% |
| Oregon | $99 | $188 | 109 | 1,121 | -2.0% |
| Hawaii | $99 | $119 | 19 | 205 | -2.1% |
| Wyoming | $98 | $156 | 47 | 763 | -2.8% |
| North Dakota | $98 | $187 | 55 | 433 | -2.9% |
| South Dakota | $98 | $172 | 42 | 524 | -3.1% |
| Florida | $97 | $183 | 715 | 12,400 | -3.4% |
| Illinois | $97 | $179 | 509 | 7,069 | -3.4% |
| Minnesota | $97 | $281 | 300 | 3,098 | -3.4% |
| Maine | $97 | $152 | 70 | 888 | -3.4% |
| Michigan | $97 | $223 | 295 | 2,397 | -3.6% |
| Texas | $97 | $184 | 365 | 4,616 | -3.7% |
| New Mexico | $97 | $168 | 30 | 373 | -4.0% |
| Idaho | $96 | $133 | 23 | 182 | -4.8% |
| Georgia | $96 | $158 | 288 | 3,999 | -4.9% |
| Utah | $96 | $128 | 78 | 1,890 | -4.9% |
| Arizona | $96 | $205 | 183 | 2,632 | -5.0% |
| Wisconsin | $95 | $254 | 317 | 2,841 | -5.2% |
| Ohio | $95 | $162 | 273 | 3,474 | -6.0% |
| Missouri | $95 | $169 | 192 | 2,695 | -6.0% |
| North Carolina | $94 | $177 | 274 | 3,088 | -6.2% |
| South Carolina | $94 | $163 | 177 | 2,887 | -6.4% |
| Nebraska | $94 | $179 | 92 | 951 | -6.8% |
| Iowa | $94 | $177 | 126 | 1,775 | -6.8% |
| Kansas | $93 | $165 | 86 | 1,298 | -7.2% |
| Indiana | $93 | $189 | 271 | 4,083 | -7.4% |
| Alabama | $93 | $132 | 99 | 1,621 | -7.7% |
| Kentucky | $93 | $166 | 162 | 1,912 | -8.0% |
| Tennessee | $92 | $170 | 241 | 3,027 | -8.2% |
| Oklahoma | $92 | $167 | 55 | 909 | -8.4% |
| Louisiana | $92 | $185 | 119 | 1,584 | -9.1% |
| West Virginia | $91 | $127 | 32 | 398 | -9.3% |
| Arkansas | $90 | $186 | 83 | 957 | -10.4% |
| Mississippi | $90 | $158 | 124 | 1,713 | -10.7% |
⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.
💊 Need post-procedure medications? Check costs on OpenPrescriber