PT Evaluation (Low Complexity) Cost in Maine
Pt eval low complex 20 min
$95.69Maine 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
Maine Medicare physician rate (2026)
-2.2% vs nationalAverage of 2 localities. Office range $94.05–$97.33.
Your ZIP in Maine
Enter a ZIP code for your part of Maine, whether the Portland area, Lewiston-Auburn, Augusta, Bangor, the midcoast, or Aroostook County in the far north.
What pt evaluation (low complexity) costs at hospitals near you
Everything above is a national average. The hospital you pick in Maine 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 Maine
Where Maine ranks for this CPT
CPT 97161 by Maine locality
| Locality | Office |
|---|---|
| southern maine | $97.33 |
| rest of maine | $94.05 |
PE GPCI ranges from 0.920 to 0.991 in Maine. That index is why the same CPT is not one price statewide.
PT Evaluation (Low Complexity) and how Maine is priced
Maine is priced as a single statewide locality with indices close to, and in parts below, the national average, so Portland and the far northern county towns share one fee schedule. CMS has never needed to subdivide a state where even the largest metro is modest by national standards. The uniform pricing belies enormous differences in access between the populous southern coast and the vast interior. For Mainers, the published statewide rates are what Medicare approves everywhere from Kittery to Fort Kent.
Maine is among the most rural states in the country and has the oldest median age, a combination that concentrates specialty care in Portland and, to a lesser degree, Bangor and Lewiston. Residents of western and northern Maine can face hours of driving for procedures, and some in the far south use Boston hospitals for complex care. Consolidation has left a small number of systems covering most of the state.
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 Maine
PT Evaluation (Low Complexity) in other states
PT Evaluation (Low Complexity) in Maine: questions
The 2026 Medicare physician office rate for CPT 97161 averages $95.69 across 2 Maine localities, from $94.05 in REST OF MAINE to $97.33 in SOUTHERN MAINE. The hospital physician rate averages $95.69. Enter a ZIP for the exact locality.
Yes. CMS splits Maine into 2 payment localities. For this CPT the office physician fee spans $3.28 from the lowest to highest locality. Enter a ZIP code for your part of Maine, whether the Portland area, Lewiston-Auburn, Augusta, Bangor, the midcoast, or Aroostook County in the far north.
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 Maine. Medigap may cover that 20%. This is not the hospital facility fee.
No. $95.69 is the Medicare physician allowed amount for CPT 97161. Anesthesia, facility fees, implants, and other CPT codes billed the same day are extra. Maine ranks #21 of 51 states on this physician line (2% below the national office rate of $97.86).