CPT
90471 — Immunization administration, single vaccine
ACA-covered vaccines should be free, including the admin fee.
Physical therapy
97167 — Occupational therapy evaluation; high complexity
This is the initial OT evaluation for patients with significant occupational performance deficits affecting multiple life areas, typically taking about 60 minutes.
- Typical setting: OT clinic, hospital outpatient
- National avg charge (illustrative): $100–$230 (highest-level OT evaluation)
- Most-disputed reason: Billing 97167 without adequately documenting multiple complex personal factors, environmental barriers, and health conditions that justify the high-complexity level.
What it means
What 97167 actually means
This is the initial OT evaluation for patients with significant occupational performance deficits affecting multiple life areas, typically taking about 60 minutes. The therapist conducts an extensive assessment requiring high-level clinical decision-making due to complex personal, environmental, and health factors.
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 97167 without adequately documenting multiple complex personal factors, environmental barriers, and health conditions that justify the high-complexity level.
- Billing for a high-complexity evaluation on a subsequent visit when only a treatment session occurred — evaluation codes are for initial or change-in-condition reassessments.
- Failing to document the typical 60-minute face-to-face time associated with the high-complexity OT evaluation.
If you see 97167 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 97167 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 97167 on a bill.
97167 FAQ
Plain-English answers.
What does 97167 usually cost?
$100–$230 (highest-level OT evaluation). 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 97167?
Billing 97167 without adequately documenting multiple complex personal factors, environmental barriers, and health conditions that justify the high-complexity level.
What should I do if I see 97167 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 97167 before paying.
Don't pay 97167 blindly.
The free scan tells you in under 60 seconds whether this charge looks reasonable for your situation.