CPT 97162 Physical Therapy/Rehab
Pt eval mod complex 30 min Cost
Body System: Musculoskeletal
Medicare Facility Rate
$98
CMS PFS CY2026
Medicare Non-Facility Rate
$98
Office/clinic setting
Relative Value Units (RVUs)
Medicare payment = Total RVU × Conversion Factor ($33.40 for CY 2026)
1.54
Work RVU
1.38
Facility PE RVU
0.01
Malpractice RVU
2.93
Total RVU
Cost by Location
| Location | Medicare Rate | Est. Commercial |
|---|---|---|
| AK — ALASKA | $127 | $165 — $254 |
| AL — ALABAMA | $92 | $120 — $185 |
| AR — ARKANSAS | $92 | $119 — $183 |
| AZ — ARIZONA | $97 | $126 — $194 |
| CA — BAKERSFIELD | $104 | $135 — $207 |
| CA — CHICO | $104 | $135 — $207 |
| CA — EL CENTRO | $104 | $135 — $207 |
| CA — FRESNO | $104 | $135 — $207 |
| CA — HANFORD-CORCORAN | $104 | $135 — $207 |
| CA — LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) | $109 | $141 — $218 |
| CA — MADERA | $104 | $135 — $207 |
| CA — MERCED | $104 | $135 — $207 |
| CA — MODESTO | $104 | $135 — $207 |
| CA — NAPA | $116 | $151 — $232 |
| CA — OXNARD-THOUSAND OAKS-VENTURA | $108 | $141 — $216 |
| CA — REDDING | $104 | $135 — $207 |
| CA — REST OF CALIFORNIA | $104 | $135 — $207 |
| CA — RIVERSIDE-SAN BERNARDINO-ONTARIO | $104 | $135 — $207 |
| CA — SACRAMENTO-ROSEVILLE-FOLSOM | $108 | $140 — $215 |
| CA — SALINAS | $107 | $139 — $214 |
Frequently Asked Questions
How much does Pt eval mod complex 30 min cost?
The Medicare facility rate is $98. Commercial insurance typically pays 150-250% of Medicare rates (varies).
How much does Pt eval mod complex 30 min cost without insurance?
Without insurance, you may pay the hospital's chargemaster rate, which is often 300-500% of Medicare. Ask about cash-pay discounts — many facilities offer 20-40% off for self-pay patients. The Medicare baseline for this procedure is $98.