PT Evaluation (Moderate Complexity) Cost in Indiana
Pt eval mod complex 30 min
$94.33Indiana 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
Indiana Medicare physician rate (2026)
-3.6% vs nationalSingle statewide locality.
Your ZIP in Indiana
Look up your ZIP for Indiana figures, whether in Indianapolis, Fort Wayne, Evansville, South Bend, the Region near Chicago, or the rural counties along the Ohio River.
What pt evaluation (moderate complexity) costs at hospitals near you
Everything above is a national average. The hospital you pick in Indiana 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 Indiana
Where Indiana ranks for this CPT
PT Evaluation (Moderate Complexity) and how Indiana is priced
Indiana's Medicare physician rates come from a single statewide locality with indices a bit under the national average, placing it in the moderate band of Midwest pricing. Indianapolis, Fort Wayne, Evansville, and the smallest rural counties all share identical geographic adjustments. Northwest Indiana sits inside the Chicago metropolitan area but is still priced under Indiana's statewide locality rather than Chicago's, which creates a visible pricing seam at the state line. For most Hoosiers the statewide fee schedule is a dependable guide to Medicare-approved amounts.
Indianapolis dominates the state's health care landscape, hosting its academic medical center and the headquarters of its largest systems, while regional hubs in Fort Wayne, Evansville, and South Bend cover their surrounding counties. Indiana's hospital prices for commercially insured patients have drawn national attention for running high relative to the region, which makes Medicare benchmarks a valuable reference for anyone paying cash. Rural southern Indiana often looks to Louisville or Cincinnati across the river.
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 Indiana
PT Evaluation (Moderate Complexity) in other states
PT Evaluation (Moderate Complexity) in Indiana: questions
Indiana is a single Medicare locality for this fee schedule. The 2026 physician rate for CPT 97162 is $94.33 in an office and $94.33 in a hospital, statewide. A ZIP lookup still confirms the locality mapping.
Not on the physician fee schedule. Indiana uses one locality, so the Medicare physician rate is the same from one end of the state to the other. What still changes is site of service (office vs hospital) and any facility fee the hospital bills on its own claim.
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 Indiana. Medigap may cover that 20%. This is not the hospital facility fee.
No. $94.33 is the Medicare physician allowed amount for CPT 97162. Anesthesia, facility fees, implants, and other CPT codes billed the same day are extra. Indiana ranks #17 of 51 states on this physician line (4% below the national office rate of $97.86).