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CPT 97167 — Ot eval high complex 60 min

CPT code 97167 (Ot eval high complex 60 min) carries 1.54 work RVUs under the CMS 2026 Medicare Physician Fee Schedule. Total RVUs are 3.01 in a non-facility setting and 3.01 in a facility setting, which at the 2026 conversion factor of $33.40 works out to $100.54 and $100.54 respectively.

1.54
Work RVU
3.01
Total RVU (non-facility)
$100.54
Medicare, non-facility
$100.54
Medicare, facility
Calculate your total wRVUs →

RVU breakdown for CPT 97167

ComponentRVUsWhat it covers
Work RVU1.54Physician time, skill, effort, and stress.
Practice expense RVU (non-facility)1.46Office overhead, staff, supplies.
Practice expense RVU (facility)1.46Overhead when performed in a hospital.
Malpractice RVU0.0Professional liability cost.
Total RVU (non-facility)3.01Work + non-facility PE + malpractice.
Total RVU (facility)3.01Work + facility PE + malpractice.

How Medicare payment is calculated

Medicare multiplies total RVUs by the annual conversion factor. For CPT 97167 in 2026:

SettingTotal RVUConversion factorNational payment
Non-facility3.01$33.40$100.54
Facility3.01$33.40$100.54

These are national amounts. Actual payment is adjusted by the Geographic Practice Cost Index for your locality — check yours with the GPCI lookup.

Billing rules for CPT 97167

Global period
Global concept does not apply to this code.
Multiple procedure reduction
Subject to the therapy multiple-procedure reduction.
Bilateral surgery
Bilateral adjustment does not apply.
Assistant surgeon
Not permitted unless documentation supports medical necessity.
Co-surgeon
Not permitted unless documentation supports medical necessity.
Team surgery
Not permitted unless documentation supports medical necessity.

Related codes

Codes in the same CMS family, with their work RVU values.

97161 · 1.54 wRVU97162 · 1.54 wRVU97163 · 1.54 wRVU97165 · 1.54 wRVU97166 · 1.54 wRVU

Questions about CPT 97167

How many work RVUs is CPT 97167?

CPT 97167 is assigned 1.54 work RVUs in the CMS 2026 Medicare Physician Fee Schedule.

What does Medicare pay for CPT 97167?

At the 2026 national conversion factor of $33.40, CPT 97167 pays approximately $100.54 in a non-facility setting and $100.54 in a facility setting before geographic adjustment.

What is the global period for CPT 97167?

Global concept does not apply to this code.

RVU values reflect the CMS 2026 Medicare Physician Fee Schedule (conversion factor $33.40). Payment figures are national and unadjusted for geography. Verify against the official fee schedule before using for billing.