PT Evaluation (Moderate Complexity) Cost in California
Pt eval mod complex 30 min
$108.00California physician fee2026 Medicare office rate- ✓Your ZIP's wage-adjusted hospital and surgery centre rates
- ✓Five nearby hospitals by name, with CMS star ratings
- ✓The add-on codes that typically land on the bill
- ✓A word-for-word script for asking for a good-faith estimate
- ✓A private link you can reopen and share
- ✓Everything in the Premium report
- ✓15 nearby hospitals instead of five
- ✓Filled good-faith-estimate request letter
- ✓Bill-negotiation letter
- ✓Printable PDF download
California Medicare physician rate (2026)
+10.4% vs nationalAverage of 29 localities. Office range $103.01–$123.74.
Your ZIP in California
A ZIP-level lookup matters more in California than in any other state; compare your area, whether that is the Bay Area, Los Angeles, San Diego, Sacramento, the Central Valley, or the rural north.
What pt evaluation (moderate complexity) costs at hospitals near you
Everything above is a national average. The hospital you pick in California moves the bill more than anything else you control.
Rates for your ZIP, 5 named hospitals with CMS ratings, the add-on codes, and the scheduler script.
One-off payment, no account and no subscription. You get a private link and an email. No medical records and no insurance card, ever.
What these numbers are
Every figure on this page is a 2026 Medicare allowed amount: the physician line comes from the Physician Fee Schedule adjusted by geographic practice-cost indices, and the facility totals come from the CMS hospital outpatient (OPPS) and ambulatory surgery centre rates. None of them is a hospital chargemaster price, your insurer's contracted rate, or a quote. Anesthesia, pathology, imaging reads and follow-up care are billed under their own codes when they apply, and an inpatient stay is paid a different way again.
National vs California
Where California ranks for this CPT
CPT 97162 by California locality
| Locality | Office |
|---|---|
| san jose-sunnyvale-santa clara (san benito cnty) | $123.74 |
| san jose-sunnyvale-santa clara (santa clara cnty) | $123.69 |
| san francisco-oakland-berkeley (marin cnty) | $121.47 |
| san francisco-oakland-berkeley (san francisco/san mateo/alameda/contra costa cnty) | $121.46 |
| napa | $115.60 |
| vallejo | $115.58 |
| santa rosa-petaluma | $109.76 |
| santa cruz-watsonville | $108.70 |
| los angeles-long beach-anaheim (los angeles/orange cnty) | $108.30 |
| san diego-chula vista-carlsbad | $108.29 |
| oxnard-thousand oaks-ventura | $107.57 |
| sacramento-roseville-folsom | $107.07 |
| santa maria-santa barbara | $106.80 |
| salinas | $106.63 |
| san luis obispo-paso robles | $104.99 |
| riverside-san bernardino-ontario | $103.17 |
| bakersfield | $103.14 |
| chico | $103.01 |
| el centro | $103.01 |
| fresno | $103.01 |
| hanford-corcoran | $103.01 |
| madera | $103.01 |
| merced | $103.01 |
| modesto | $103.01 |
| redding | $103.01 |
| stockton | $103.01 |
| visalia | $103.01 |
| yuba city | $103.01 |
| rest of california | $103.01 |
PE GPCI ranges from 1.096 to 1.442 in California. That index is why the same CPT is not one price statewide.
PT Evaluation (Moderate Complexity) and how California is priced
California is the most finely divided state in the Medicare fee schedule, with roughly thirty payment localities drawn around metropolitan statistical areas after CMS reformed the state's locality map. The San Francisco Bay Area carries some of the highest geographic adjustments in the nation, with San Francisco, San Jose, and the East Bay each priced separately, while Los Angeles, Orange County, San Diego, and Sacramento have their own localities at somewhat lower levels. Rural and inland counties fall into lower-cost localities, so the same procedure can carry meaningfully different Medicare-approved amounts within a single day's drive. No other state shows this much in-state variation on the fee schedule itself.
California's markets differ sharply: the Bay Area combines high wages with heavily consolidated hospital systems, Los Angeles offers enormous choice across a sprawling region, and the Central Valley and far north face genuine access shortages. Where you are treated within the state matters more here than almost anywhere else in the country. Academic medical centers in the Bay Area, Los Angeles, San Diego, and Sacramento handle much of the complex referral care.
This procedure: This is the moderate-complexity initial physical therapy evaluation, used when your situation has real complicating factors: one or more health conditions affecting rehab, an evolving rather than stable presentation, or changed function in daily activities. A typical example is knee rehab in someone with diabetes and prior joint surgery. The PT takes a more extensive history and examines more body systems than in a simple case, usually across a 45 to 75 minute appointment that often ends with the first treatment.
What Is PT Evaluation (Moderate Complexity)?
This is the moderate-complexity initial physical therapy evaluation, used when your situation has real complicating factors: one or more health conditions affecting rehab, an evolving rather than stable presentation, or changed function in daily activities. A typical example is knee rehab in someone with diabetes and prior joint surgery. The PT takes a more extensive history and examines more body systems than in a simple case, usually across a 45 to 75 minute appointment that often ends with the first treatment.
What Affects the Cost
- –As the middle evaluation tier, some commercial payers price it above the low-complexity code, while Medicare pays all three tiers equally.
- –Complicated patients tend to need longer courses of care, so the evaluation tier itself signals a larger total spend ahead.
- –First-day treatment units bill in addition to the evaluation.
- –Comorbidities can mean coordination with physicians or extra documentation, occasionally generating separate visits elsewhere.
- –Clinic ownership matters as always: hospital-affiliated clinics add facility fees to every encounter including this one.
Questions to Ask Before Booking
- 1.What makes my case moderate complexity, and does that tier change what I pay under my plan?
- 2.Given my other health conditions, how long a course of therapy should I budget for?
- 3.Will you treat me on evaluation day, and what will that first combined visit cost?
- 4.Does my insurer require a referral or pre-authorization before this evaluation?
- 5.How will you coordinate with my physician, and does that generate any separate charges?
Other featured procedures in California
PT Evaluation (Moderate Complexity) in other states
PT Evaluation (Moderate Complexity) in California: questions
The 2026 Medicare physician office rate for CPT 97162 averages $108.00 across 29 California localities, from $103.01 in CHICO to $123.74 in SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY). The hospital physician rate averages $108.00. Enter a ZIP for the exact locality.
Yes. CMS splits California into 29 payment localities. For this CPT the office physician fee spans $20.73 from the lowest to highest locality. A ZIP-level lookup matters more in California than in any other state; compare your area, whether that is the Bay Area, Los Angeles, San Diego, Sacramento, the Central Valley, or the rural north.
After the Part B deductible, coinsurance is usually 20% of the allowed amount: about $22 for the office physician line or $22 for the hospital physician line in California. Medigap may cover that 20%. This is not the hospital facility fee.
No. $108.00 is the Medicare physician allowed amount for CPT 97162. Anesthesia, facility fees, implants, and other CPT codes billed the same day are extra. California ranks #49 of 51 states on this physician line (10% above the national office rate of $97.86).