PT Evaluation (Low Complexity) Cost in Kansas
Pt eval low complex 20 min
Kansas Medicare physician rate (2026)
-4.7% vs nationalSingle statewide locality.
Your ZIP in Kansas
Enter a ZIP code for your part of Kansas, from Overland Park and the Kansas City suburbs to Wichita, Topeka, Lawrence, Salina, and the western High Plains.
What this number is
The figures on this page are 2026 Medicare physician allowed amounts for a specific CPT code: the professional fee, adjusted by geographic practice-cost indices. They are not a hospital chargemaster price, not your insurer's contracted rate, and not a quote. Hospital facility fees, anesthesia, implants, imaging reads, and pathology are billed separately when they apply.
National vs Kansas
Where Kansas ranks for this CPT
PT Evaluation (Low Complexity) and how Kansas is priced
A single locality covers all of Kansas, with geographic indices in the lower national tier, so the published Medicare rates apply evenly from the Kansas City suburbs to the far western High Plains. Notably, the Kansas side of the Kansas City metro prices under the statewide Kansas locality while the Missouri side has its own metro locality, meaning the two halves of one city carry different approved amounts. Beyond that quirk, Kansas pricing is straightforwardly uniform. Wichita, Topeka, and rural Kansas all share the same adjustments.
The Kansas City metro and Wichita hold most of the state's specialists, with the academic medical center on the Kansas side of the metro serving as the top referral point. Western Kansas is genuinely frontier in places, with long distances to any hospital that performs advanced procedures, and some High Plains residents cross into Colorado or Nebraska for care. Critical access hospitals carry much of the rural load.
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 Kansas
PT Evaluation (Low Complexity) in other states
PT Evaluation (Low Complexity) in Kansas: questions
How much does pt evaluation (low complexity) cost in Kansas?
Kansas is a single Medicare locality for this fee schedule. The 2026 physician rate for CPT 97161 is $93.27 in an office and $93.27 in a hospital, statewide. A ZIP lookup still confirms the locality mapping.
Does the rate change inside Kansas?
Not on the physician fee schedule. Kansas 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.
What will a Medicare patient owe for the physician fee?
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 Kansas. Medigap may cover that 20%. This is not the hospital facility fee.
Is this the full pt evaluation (low complexity) bill in Kansas?
No. $93.27 is the Medicare physician allowed amount for CPT 97161. Anesthesia, facility fees, implants, and other CPT codes billed the same day are extra. Kansas ranks #7 of 51 states on this physician line (5% below the national office rate of $97.86).