PT Evaluation (Low Complexity) Cost in Iowa
Pt eval low complex 20 min
$93.75Iowa 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
Iowa Medicare physician rate (2026)
-4.2% vs nationalSingle statewide locality.
Your ZIP in Iowa
Try your ZIP code to see local context, whether you are in Des Moines, Iowa City, Cedar Rapids, the Quad Cities, Sioux City, or one of Iowa's many rural counties.
What pt evaluation (low complexity) costs at hospitals near you
Everything above is a national average. The hospital you pick in Iowa 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 Iowa
Where Iowa ranks for this CPT
PT Evaluation (Low Complexity) and how Iowa is priced
Iowa is priced as one statewide locality, and its low geographic indices have long placed Medicare-approved amounts here among the lowest in the nation, a point the state's medical community has repeatedly raised with Washington. Des Moines and the smallest farm towns share the same fee schedule adjustments. The single locality means the university medical center in Iowa City bills against the same geographic factors as a rural clinic. Consumers comparing across state lines will often find Iowa procedure prices lower than in Illinois or Minnesota metros.
Care in Iowa is organized around Des Moines, the university hospital in Iowa City, and regional hubs like Cedar Rapids, Davenport, and Sioux City, each serving broad rural catchments. Many small counties have hospitals with limited procedure offerings, so referrals up the chain are routine. Residents on the state's edges commonly cross into Omaha, the Quad Cities, or Rochester, Minnesota for specialty 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 Iowa
PT Evaluation (Low Complexity) in other states
PT Evaluation (Low Complexity) in Iowa: questions
Iowa is a single Medicare locality for this fee schedule. The 2026 physician rate for CPT 97161 is $93.75 in an office and $93.75 in a hospital, statewide. A ZIP lookup still confirms the locality mapping.
Not on the physician fee schedule. Iowa 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 Iowa. Medigap may cover that 20%. This is not the hospital facility fee.
No. $93.75 is the Medicare physician allowed amount for CPT 97161. Anesthesia, facility fees, implants, and other CPT codes billed the same day are extra. Iowa ranks #9 of 51 states on this physician line (4% below the national office rate of $97.86).