PT Evaluation (Low Complexity) Cost in Georgia
Pt eval low complex 20 min
$95.89Georgia 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
Georgia Medicare physician rate (2026)
-2.0% vs nationalAverage of 2 localities. Office range $92.95–$98.82.
Your ZIP in Georgia
Look up your ZIP to see whether Atlanta-area or rest-of-state pricing applies, from the metro counties to Savannah, Augusta, Columbus, Macon, and rural south Georgia.
What pt evaluation (low complexity) costs at hospitals near you
Everything above is a national average. The hospital you pick in Georgia 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 Georgia
Where Georgia ranks for this CPT
CPT 97161 by Georgia locality
| Locality | Office |
|---|---|
| atlanta | $98.82 |
| rest of georgia | $92.95 |
PE GPCI ranges from 0.892 to 1.016 in Georgia. That index is why the same CPT is not one price statewide.
PT Evaluation (Low Complexity) and how Georgia is priced
Georgia divides into an Atlanta metro locality and a rest-of-state locality, so the fee schedule itself recognizes the cost gap between the capital region and the rest of the state. Atlanta's higher wages and rents translate into higher Medicare-approved amounts inside its locality, while Savannah, Augusta, Columbus, Macon, and rural Georgia share the lower rest-of-state pricing. The split is one of the cleaner examples of a two-tier state in the fee schedule. Patients near the locality boundary can see different approved amounts a short drive apart.
Metro Atlanta concentrates the state's academic medicine and most of its subspecialists, drawing referrals from across the Southeast. Outside the metro, south Georgia has seen repeated rural hospital closures, leaving longer trips for even routine procedures in some counties. Augusta and Savannah serve as important secondary hubs, and border residents sometimes cross into Chattanooga, Tallahassee, or Jacksonville for care.
This procedure: This is the initial physical therapy evaluation for straightforward cases: a low-complexity assessment where the PT reviews your history, examines movement, strength, and function, and builds your treatment plan. It applies when you have no significant complicating factors, for example a recent simple ankle sprain in an otherwise healthy person. The appointment usually runs 30 to 60 minutes and often includes the first treatment, which is billed separately on top.
What Is PT Evaluation (Low Complexity)?
This is the initial physical therapy evaluation for straightforward cases: a low-complexity assessment where the PT reviews your history, examines movement, strength, and function, and builds your treatment plan. It applies when you have no significant complicating factors, for example a recent simple ankle sprain in an otherwise healthy person. The appointment usually runs 30 to 60 minutes and often includes the first treatment, which is billed separately on top.
What Affects the Cost
- –The evaluation is a one-time charge at the start of care, usually priced above a standard treatment visit.
- –Treatment codes billed at the same first visit stack on top of the evaluation fee.
- –Complexity tiering matters: this low-complexity code is the least expensive of the three PT evaluation levels under many commercial fee schedules, though Medicare currently pays all three tiers the same.
- –Direct access rules let you start PT without a physician referral in most states, saving a doctor visit, but some insurers still require a referral for payment.
- –Hospital outpatient therapy departments attach facility fees to the evaluation that private clinics do not.
Questions to Ask Before Booking
- 1.Do I need a physician referral for my insurance to pay, even though my state allows direct access?
- 2.What does the evaluation cost, and will treatment on the same day be billed on top?
- 3.Does the evaluation count against my plan's annual visit limit?
- 4.After evaluating me, how many visits and units per visit do you anticipate?
- 5.Is your clinic hospital-owned, and is there a facility fee on this evaluation?
Other featured procedures in Georgia
PT Evaluation (Low Complexity) in other states
PT Evaluation (Low Complexity) in Georgia: questions
The 2026 Medicare physician office rate for CPT 97161 averages $95.89 across 2 Georgia localities, from $92.95 in REST OF GEORGIA to $98.82 in ATLANTA. The hospital physician rate averages $95.89. Enter a ZIP for the exact locality.
Yes. CMS splits Georgia into 2 payment localities. For this CPT the office physician fee spans $5.87 from the lowest to highest locality. Look up your ZIP to see whether Atlanta-area or rest-of-state pricing applies, from the metro counties to Savannah, Augusta, Columbus, Macon, and rural south Georgia.
After the Part B deductible, coinsurance is usually 20% of the allowed amount: about $19 for the office physician line or $19 for the hospital physician line in Georgia. Medigap may cover that 20%. This is not the hospital facility fee.
No. $95.89 is the Medicare physician allowed amount for CPT 97161. Anesthesia, facility fees, implants, and other CPT codes billed the same day are extra. Georgia ranks #23 of 51 states on this physician line (2% below the national office rate of $97.86).