CPT
90471 — Immunization administration, single vaccine
ACA-covered vaccines should be free, including the admin fee.
Physical therapy
97166 — Occupational therapy evaluation; moderate complexity
This is the initial OT evaluation for patients with moderate functional limitations affecting daily living, work, or self-care, typically taking about 45 minutes.
- Typical setting: OT clinic, hospital outpatient
- National avg charge (illustrative): $90–$210 (moderate complexity OT evaluation)
- Most-disputed reason: Not distinguishing between OT evaluation complexity levels in documentation — each level (97165, 97166, 97167) requires specific documented clinical findings to support the selected code.
What it means
What 97166 actually means
This is the initial OT evaluation for patients with moderate functional limitations affecting daily living, work, or self-care, typically taking about 45 minutes. The therapist evaluates multiple performance areas and comorbidities affecting your ability to function independently.
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).
- Not distinguishing between OT evaluation complexity levels in documentation — each level (97165, 97166, 97167) requires specific documented clinical findings to support the selected code.
- Billing the OT evaluation when only a PT evaluation was documented — verify which discipline performed each evaluation on your Explanation of Benefits.
- OTA (occupational therapy assistant) billing an evaluation code — OTAs cannot independently bill evaluation codes; evaluations must be performed by a licensed OT.
If you see 97166 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 97166 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 97166 on a bill.
97166 FAQ
Plain-English answers.
What does 97166 usually cost?
$90–$210 (moderate complexity 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 97166?
Not distinguishing between OT evaluation complexity levels in documentation — each level (97165, 97166, 97167) requires specific documented clinical findings to support the selected code.
What should I do if I see 97166 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 97166 before paying.
Don't pay 97166 blindly.
The free scan tells you in under 60 seconds whether this charge looks reasonable for your situation.