How Much Does Physical Therapy Evaluation - Moderate Complexity Cost?
Also known as: Pt eval mod complex 30 min (CPT 97162)
A physical therapy evaluation for a condition of moderate complexity.
Physical Therapy Evaluation - Moderate Complexity (CPT 97162) costs $98 at Medicare rates.
Patient Guide: Physical Therapy Evaluation - Moderate Complexity
What you need to know before your appointment
What to Expect
A physical therapist will perform a thorough assessment including multiple tests of strength, flexibility, balance, and function, then create a detailed treatment plan.
How Long Does It Take?
45-60 minutes
Common Reasons Doctors Order This
Multiple-area injuries, post-surgical rehabilitation, moderate musculoskeletal conditions, chronic pain evaluation
How to Prepare
Bring your referral and any imaging reports. Wear comfortable clothing. Prepare to describe your condition history and goals.
Procedures Commonly Done Together
These procedures are frequently performed alongside Pt eval mod complex 30 min
What Insurance Companies Actually Pay
Real negotiated rates from 9 hospitals across 5 states (from hospital price transparency filings)
| Insurance Company | Avg Rate | Range | Hospitals |
|---|---|---|---|
| Aetna | $356 | $64 - $547 | 8 |
| Superior Health Plan | $95 | $91 - $103 | 3 |
| Cigna HealthSpring | $90 | $86 - $98 | 5 |
| WellCare | $93 | $89 - $101 | 5 |
| United | $205 | $70 - $409 | 9 |
| Provider Partners Health Plan of Texas | $96 | $91 - $104 | 3 |
| Bright Health | $98 | $89 - $204 | 2 |
| Humana | $239 | $86 - $806 | 6 |
| BCBS | $166 | $86 - $290 | 3 |
| Superior | $137 | $125 - $152 | 3 |
| Cigna | $280 | $121 - $434 | 4 |
| Kaiser | $153 | $91 - $241 | 2 |
How to Reduce Your Cost for Pt eval mod complex 30 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
Frequently Asked Questions
How much does Pt eval mod complex 30 min cost?
The Medicare facility rate for Pt eval mod complex 30 min is $98. Commercial insurance rates typically range from 150% to 250% of Medicare (varies by plan).
How much does Pt eval mod complex 30 min cost without insurance?
Without insurance, the cost of Pt eval mod complex 30 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 mod complex 30 min?
Most commercial health insurance plans and Medicare cover Pt eval mod complex 30 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.