PT Evaluation (Moderate Complexity) Cost in Louisiana
Pt eval mod complex 30 min
$93.87Louisiana 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
Louisiana Medicare physician rate (2026)
-4.1% vs nationalAverage of 2 localities. Office range $92.55–$95.19.
Your ZIP in Louisiana
Check your ZIP code to see whether New Orleans locality pricing or rest-of-state pricing applies, from the metro area to Baton Rouge, Lafayette, Shreveport, and the rural parishes.
What pt evaluation (moderate complexity) costs at hospitals near you
Everything above is a national average. The hospital you pick in Louisiana 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 Louisiana
Where Louisiana ranks for this CPT
CPT 97162 by Louisiana locality
| Locality | Office |
|---|---|
| new orleans | $95.19 |
| rest of louisiana | $92.55 |
PE GPCI ranges from 0.885 to 0.941 in Louisiana. That index is why the same CPT is not one price statewide.
PT Evaluation (Moderate Complexity) and how Louisiana is priced
Louisiana is one of the states CMS splits: the New Orleans area has its own payment locality, and the rest of the state, including Baton Rouge, Shreveport, and Lafayette, shares a second. New Orleans carries somewhat higher geographic adjustments, so identical procedures are approved at higher amounts there than elsewhere in the state. The two-locality structure has been stable for years and mirrors the metro's higher wage and rent levels. Everywhere outside greater New Orleans prices off the same rest-of-state factors.
New Orleans remains the state's medical center of gravity, with academic medicine and the deepest specialist bench, while Baton Rouge, Shreveport, Lafayette, and Lake Charles anchor their own regions. Rural parishes, especially in the north and along the coast, have limited hospital capacity and refer heavily into the cities. Louisiana's high rates of chronic disease keep demand for procedures strong across the state.
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 Louisiana
PT Evaluation (Moderate Complexity) in other states
PT Evaluation (Moderate Complexity) in Louisiana: questions
The 2026 Medicare physician office rate for CPT 97162 averages $93.87 across 2 Louisiana localities, from $92.55 in REST OF LOUISIANA to $95.19 in NEW ORLEANS. The hospital physician rate averages $93.87. Enter a ZIP for the exact locality.
Yes. CMS splits Louisiana into 2 payment localities. For this CPT the office physician fee spans $2.64 from the lowest to highest locality. Check your ZIP code to see whether New Orleans locality pricing or rest-of-state pricing applies, from the metro area to Baton Rouge, Lafayette, Shreveport, and the rural parishes.
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 Louisiana. Medigap may cover that 20%. This is not the hospital facility fee.
No. $93.87 is the Medicare physician allowed amount for CPT 97162. Anesthesia, facility fees, implants, and other CPT codes billed the same day are extra. Louisiana ranks #11 of 51 states on this physician line (4% below the national office rate of $97.86).