PT Evaluation (Moderate Complexity)
Pt eval mod complex 30 min
National Average Cost (2026)
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Procedure Details
Understanding the Cost
Medicare rate is the amount Medicare pays providers. If you have Medicare, you typically pay 20% of this amount after your deductible.
Private insurance plans negotiate their own rates, typically 130-200% of Medicare. Your out-of-pocket cost depends on your deductible, copay, and coinsurance.
Self-pay/cash prices vary widely. Many providers offer cash discounts of 20-40% off their standard charges. Always ask about cash pricing.
Office vs Hospital: the same procedure often costs less in a doctor's office than a hospital, because hospitals charge a separate facility fee.
Ways to Save on This Procedure
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Many consultations can be done virtually for $50-100, saving hundreds vs an in-person visit.
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More ways to save →PT Evaluation (Moderate Complexity) (CPT 97162): Frequently Asked Questions
How much does pt evaluation (moderate complexity) cost?
The 2026 national Medicare rate for pt evaluation (moderate complexity) (CPT 97162) is $97.86 in an office setting and $97.86 in a hospital. Private insurance usually pays $127 to $196, and self-pay cash prices often run $78 to $147. Enter your ZIP code for a locality-adjusted rate.
Why does pt evaluation (moderate complexity) cost more in a hospital than an office?
Medicare pays a separate facility fee to hospitals, so the hospital (facility) rate of $97.86 differs from the office (non-facility) rate of $97.86. Where clinically appropriate, having the procedure in an office or outpatient setting is often cheaper.
What is CPT code 97162?
CPT code 97162 is the standard medical billing code for pt evaluation (moderate complexity). Providers use it to bill insurers, and Medicare sets a national reimbursement rate for it that is adjusted by geographic locality.
How can I pay less for pt evaluation (moderate complexity)?
Ask the provider for a self-pay or cash price before booking, as many discount 20-40% for upfront payment. If you are uninsured, compare marketplace insurance plans, consider telehealth for the consultation, and check prescription discount cards for any follow-up medication.