CPT
90471 — Immunization administration, single vaccine
ACA-covered vaccines should be free, including the admin fee.
Physical therapy
97165 — Occupational therapy evaluation; low complexity
This is the initial occupational therapy evaluation for patients with straightforward conditions, typically taking about 30 minutes.
- Typical setting: OT clinic, hospital outpatient
- National avg charge (illustrative): $80–$190 (Medicare non-facility national average approximately $98 in 2026)
- Most-disputed reason: Billing 97165 without the required GO modifier for Medicare claims — GO identifies the service as provided under an occupational therapy plan of care.
What it means
What 97165 actually means
This is the initial occupational therapy evaluation for patients with straightforward conditions, typically taking about 30 minutes. The therapist assesses your ability to perform daily activities (dressing, cooking, working) and develops a treatment plan to improve function.
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).
- Billing 97165 without the required GO modifier for Medicare claims — GO identifies the service as provided under an occupational therapy plan of care.
- Confusing PT evaluation codes (97161–97163) with OT evaluation codes (97165–97167) — PT and OT are distinct disciplines with different billing requirements and modifiers.
- Billing an OT evaluation on the same day as a PT evaluation for the same body region without documentation that both evaluations were clinically necessary and distinct.
If you see 97165 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 97165 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 97165 on a bill.
97165 FAQ
Plain-English answers.
What does 97165 usually cost?
$80–$190 (Medicare non-facility national average approximately $98 in 2026). 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 97165?
Billing 97165 without the required GO modifier for Medicare claims — GO identifies the service as provided under an occupational therapy plan of care.
What should I do if I see 97165 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 97165 before paying.
Don't pay 97165 blindly.
The free scan tells you in under 60 seconds whether this charge looks reasonable for your situation.