CPT 97016: what Medicare pays in 2026
Physical therapy or rehabilitation
Medicare's 2026 national amount for 97016 is $12.02 when a doctor's office or clinic bills it. Across Medicare's 109 payment localities the office amount runs from $11.06 in Arkansas to $15.25 in Alaska.
CPT descriptions are copyrighted by the American Medical Association, so this page shows the code number only. The description printed on your bill, or the provider, will tell you what the code covers.
Medicare amounts for 97016 in 2026
- Doctor's office or clinic, national
- $12.02
- Hospital outpatient status A
- paid from a different Medicare fee schedule, not the outpatient system
What providers charged Medicare for 97016 in 2024
From CMS's national utilization file (the most recent full year published). The charge is the provider's list price, the same kind of figure an uninsured patient is usually billed.
| Setting | Services | Average charge | Medicare allowed | Charge vs allowed |
|---|---|---|---|---|
| In an office or other non-facility setting | 988,655 | $45.24 | $8.55 | 5.3× |
How Medicare builds the 97016 amount
Each physician fee schedule amount is three relative value units (RVUs), each multiplied by the locality's cost index, added up and multiplied by the 2026 conversion factor of $33.4009.
- Work RVU
- 0.18
- Practice expense RVU, office
- 0.17
- Malpractice RVU
- 0.01
97016 in every Medicare locality
The office amount is lowest in Arkansas and highest in Alaska.