PT Evaluation (Moderate Complexity) Cost in Maine
Pt eval mod complex 30 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 (moderate 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 97162 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 (Moderate 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 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 Maine
PT Evaluation (Moderate Complexity) in other states
PT Evaluation (Moderate Complexity) in Maine: questions
The 2026 Medicare physician office rate for CPT 97162 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 97162. 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).