CPT
90471 — Immunization administration, single vaccine
ACA-covered vaccines should be free, including the admin fee.
Physical therapy
97162 — Physical therapy evaluation; moderate complexity
This is the initial physical therapy evaluation for patients with 1-2 personal factors or comorbidities affecting care, typically taking about 30 minutes.
- Typical setting: PT clinic, hospital outpatient
- National avg charge (illustrative): $85–$200 (similar range to 97161 and 97163; complexity determines appropriate code selection, not payment level)
- Most-disputed reason: Selecting 97162 without documenting the specific personal factors or comorbidities that make the case moderate complexity rather than low or high complexity.
What it means
What 97162 actually means
This is the initial physical therapy evaluation for patients with 1-2 personal factors or comorbidities affecting care, typically taking about 30 minutes. The therapist examines your body systems using multiple measurement areas and determines a treatment plan for your moderately complex condition.
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).
- Selecting 97162 without documenting the specific personal factors or comorbidities that make the case moderate complexity rather than low or high complexity.
- Billing any PT evaluation code (97161–97163) more than once per episode of care without documentation of a change requiring a new evaluation.
- Missing the GP modifier on Medicare claims, which is required to confirm services are furnished under a physical therapist plan of care.
If you see 97162 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 97162 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 97162 on a bill.
97162 FAQ
Plain-English answers.
What does 97162 usually cost?
$85–$200 (similar range to 97161 and 97163; complexity determines appropriate code selection, not payment level). 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 97162?
Selecting 97162 without documenting the specific personal factors or comorbidities that make the case moderate complexity rather than low or high complexity.
What should I do if I see 97162 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 97162 before paying.
Don't pay 97162 blindly.
The free scan tells you in under 60 seconds whether this charge looks reasonable for your situation.