How Much Does Physical Therapy Evaluation - Low Complexity Cost?
Also known as: Pt eval low complex 20 min (CPT 97161)
A physical therapy evaluation for a condition of low complexity.
Physical Therapy Evaluation - Low Complexity (CPT 97161) costs $98 at Medicare rates.
Patient Guide: Physical Therapy Evaluation - Low Complexity
What you need to know before your appointment
What to Expect
A physical therapist will assess your condition, test range of motion, strength, and function, and develop a treatment plan for a relatively straightforward problem.
How Long Does It Take?
30-45 minutes
Common Reasons Doctors Order This
Simple muscle strain, ankle sprain, post-surgical evaluation, minor injury rehabilitation
How to Prepare
Bring your doctor referral. Wear comfortable, flexible clothing. List your goals for therapy.
Procedures Commonly Done Together
These procedures are frequently performed alongside Pt eval low complex 20 min
What Insurance Companies Actually Pay
Real negotiated rates from 8 hospitals across 5 states (from hospital price transparency filings)
| Insurance Company | Avg Rate | Range | Hospitals |
|---|---|---|---|
| Aetna | $380 | $62 - $534 | 8 |
| BCBS | $208 | $86 - $290 | 2 |
| United | $188 | $70 - $338 | 8 |
| Cigna HealthSpring | $94 | $86 - $101 | 4 |
| WellCare | $97 | $89 - $104 | 4 |
| Superior Health Plan | $97 | $91 - $103 | 2 |
| Bright Health | $101 | $101 | 2 |
| Humana | $346 | $86 - $806 | 5 |
| Provider Partners Health Plan of Texas | $98 | $91 - $104 | 2 |
| Superior | $140 | $125 - $152 | 2 |
| BCBS-TX | $216 | $169 - $273 | 1 |
| Cigna | $156 | $121 - $255 | 3 |
How to Reduce Your Cost for Pt eval low complex 20 min
Practical tips that can save you hundreds or thousands of dollars
- 1 Ask about cash-pay discounts
Many hospitals and clinics offer 20-40% discounts for self-pay patients. Always ask before scheduling.
- 2 Compare facility vs. office setting costs
Some procedures cost significantly less in an office setting than a hospital. Ask your provider about options.
- 3 Shop around — costs vary significantly
Costs can vary 2-3x between providers in the same city. Get quotes from multiple facilities.
How is the Price Calculated?
Medicare calculates procedure payments using Relative Value Units (RVUs). Each procedure has three components multiplied by a conversion factor ($33.40 in 2026) and adjusted by geographic cost indices.
Payment = Total RVU (2.93) x CF ($33.40) = $98
Related Procedures
Similar procedures in the same category or body system
People Also Ask
Common questions people search for about this procedure
How much is a 30 minute physical therapy session?
The cost of physical therapy varies based on factors like complexity, insurance coverage, and the setting of the therapy. On average, sessions range from 5 to 20 in the United States, with rates around 00 to 50 for specialized services or in-home therapy.
Can physical therapy help with sciatica?
Can physical therapy help with vertigo?
What is included in a physical therapy evaluation?
Frequently Asked Questions
How much does Pt eval low complex 20 min cost?
The Medicare facility rate for Pt eval low complex 20 min is $98. Commercial insurance rates typically range from 150% to 250% of Medicare (varies by plan).
How much does Pt eval low complex 20 min cost without insurance?
Without insurance, the cost of Pt eval low complex 20 min can range from 150% of Medicare to 500% of Medicare depending on the facility. Many hospitals and clinics offer self-pay discounts of 20-40% off their chargemaster price. Always ask about cash pricing before your visit.
Does insurance cover Pt eval low complex 20 min?
Most commercial health insurance plans and Medicare cover Pt eval low complex 20 min when ordered by a physician for a medically necessary reason. Your out-of-pocket cost depends on your plan's deductible, copay/coinsurance structure, and whether you use an in-network provider. Check with your insurance company before scheduling to confirm coverage and get a cost estimate.
Why does the cost vary so much by location?
Medicare adjusts payments using Geographic Practice Cost Indices (GPCIs) that reflect local differences in physician work costs, practice expenses, and malpractice insurance. Manhattan, San Francisco, and other high-cost areas pay significantly more than rural regions. Commercial insurers follow similar geographic patterns.