CPT 97167Occupational TherapyUntimed · per session

OT evaluation — high complexity

Occupational therapy session illustration

What CPT 97167 covers

CPT 97167 is the high-complexity OT evaluation: comprehensive history, 5+ performance deficits, and high-complexity clinical decision-making.

Using 97167 on superbills

Fits medically complex children — multiple diagnoses, equipment needs, multi-domain deficits.
Your report should clearly enumerate five or more performance deficits to support this level.

Documentation that supports it

Comprehensive occupational profile with medical and therapy history
Multiple standardized assessments and complex care coordination notes

Common ICD-10 pairings

Examples seen in pediatric practice — always code the diagnosis that fits the client.

G80.9F84.0Q90.9

FAQ

When should a pediatric OT bill 97167?

When the child has comorbidities affecting occupational performance, five or more deficits, and decision-making is genuinely high complexity — and the documentation shows it.

97165OT evaluation — low complexity 97166OT evaluation — moderate complexity 97168OT re-evaluation

Educational reference only — not billing, coding, or legal advice. CPT® is a registered trademark of the American Medical Association. Verify current code definitions and payer policies before billing.