CPT
90471 — Immunization administration, single vaccine
ACA-covered vaccines should be free, including the admin fee.
Physical therapy
97163 — Physical therapy evaluation; high complexity
This is the initial physical therapy evaluation for patients with multiple personal factors and comorbidities significantly affecting care, typically taking about 45 minutes.
- Typical setting: PT clinic, hospital outpatient
- National avg charge (illustrative): $90–$220 (upper end of PT evaluation range)
- Most-disputed reason: Routinely defaulting to 97163 without adequate documentation of the specific complexity factors — the high-complexity code requires documented evidence of multiple complicating factors affecting care.
What it means
What 97163 actually means
This is the initial physical therapy evaluation for patients with multiple personal factors and comorbidities significantly affecting care, typically taking about 45 minutes. The therapist addresses multiple body systems and requires high-level clinical decision-making to develop the treatment plan.
Common errors with this code
What goes wrong on real bills.
Most bills that look correct still contain at least one of these issues. Up to 49% of medical bills contain errors (CFPB).
- Routinely defaulting to 97163 without adequate documentation of the specific complexity factors — the high-complexity code requires documented evidence of multiple complicating factors affecting care.
- Billing 97163 and then billing 97164 (re-evaluation) on subsequent dates as routine — re-evaluations require documented changes necessitating a revised plan of care.
- Billing 97163 for return visits after a break in care when a new evaluation was not actually conducted.
If you see 97163 on your bill
Three steps before paying.
1. Get the itemized bill. If your statement only shows a summary, request the CPT-level itemized bill before paying. Generate the request language →
2. Cross-check against the EOB. Compare what your insurer's Explanation of Benefits says you owe versus what the hospital is asking. They disagree more often than people think. Read the bill-vs-EOB guide →
3. Run a free Bill Scan. Upload the bill (and EOB if you have it) and BillBusted will flag the most likely issues with this specific code in your specific state. Run free scan →
Related codes
Other codes in this category.
People who land on 97163 often also see these adjacent codes on the same bill.
CPT
90472 — Immunization admin; each additional vaccine
Vaccine — admin (90471) is separate from the vaccine product code.
CPT
90651 — Human papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonavalent , IM
Vaccine — admin (90471) is separate from the vaccine product code.
CPT
90670 — Pneumococcal conjugate vaccine, 13 valent , IM
Vaccine — admin (90471) is separate from the vaccine product code.
CPT
90671 — Pneumococcal conjugate vaccine, 15 valent , IM
Vaccine — admin (90471) is separate from the vaccine product code.
CPT
90677 — Pneumococcal conjugate vaccine, 20 valent , IM
Vaccine — admin (90471) is separate from the vaccine product code.
Related BillBusted guides
Plain-English reads if you see 97163 on a bill.
97163 FAQ
Plain-English answers.
What does 97163 usually cost?
$90–$220 (upper end of PT evaluation range). Costs vary by region, payer contract, and whether the service was performed in a hospital outpatient department (which adds a facility fee) versus a free-standing clinic.
What's the most common billing error on 97163?
Routinely defaulting to 97163 without adequate documentation of the specific complexity factors — the high-complexity code requires documented evidence of multiple complicating factors affecting care.
What should I do if I see 97163 on my bill?
Request the itemized bill and the matching EOB from your insurer. Compare the units/quantity billed against what you actually received. Run a free BillBusted scan to flag the most likely errors specific to 97163 before paying.
Don't pay 97163 blindly.
The free scan tells you in under 60 seconds whether this charge looks reasonable for your situation.