PT Evaluation (Moderate Complexity) Cost in Maryland
Pt eval mod complex 30 min
$100.52Maryland 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
Maryland Medicare physician rate (2026)
+2.7% vs nationalAverage of 2 localities. Office range $98.90–$102.13.
Your ZIP in Maryland
A ZIP lookup matters in Maryland because three different locality treatments are in play: check whether you fall in the Baltimore area, the DC suburbs like Bethesda and Silver Spring, or rest-of-state regions like Frederick, Hagerstown, and the Eastern Shore.
What pt evaluation (moderate complexity) costs at hospitals near you
Everything above is a national average. The hospital you pick in Maryland 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 Maryland
Where Maryland ranks for this CPT
CPT 97162 by Maryland locality
| Locality | Office |
|---|---|
| baltimore/surr. cntys | $102.13 |
| rest of maryland | $98.90 |
PE GPCI ranges from 1.012 to 1.073 in Maryland. That index is why the same CPT is not one price statewide.
PT Evaluation (Moderate Complexity) and how Maryland is priced
Maryland's Medicare physician pricing is split geographically: Baltimore and its surrounding counties form one locality, the rest of the state another, and, unusually, the Washington suburbs including Montgomery and Prince George's counties are priced inside the District of Columbia's high-cost locality rather than either Maryland one. That three-way carve means a Rockville procedure is approved at DC-area rates while an identical one in Frederick or Salisbury is not. Baltimore-area adjustments sit above rest-of-state levels but below the DC locality. Few states have their pricing shaped this much by a neighboring jurisdiction.
Maryland is also the only state with an all-payer rate-setting system for hospital services, so hospital-side billing works differently here than anywhere else in the country, though physician fees still follow the standard Medicare schedule. Baltimore's academic medical centers rank among the most prominent in the world and draw patients globally. The Eastern Shore and western Maryland are far more rural, with patients often traveling to Baltimore, Annapolis, or across state lines.
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 Maryland
PT Evaluation (Moderate Complexity) in other states
PT Evaluation (Moderate Complexity) in Maryland: questions
The 2026 Medicare physician office rate for CPT 97162 averages $100.52 across 2 Maryland localities, from $98.90 in REST OF MARYLAND to $102.13 in BALTIMORE/SURR. CNTYS. The hospital physician rate averages $100.52. Enter a ZIP for the exact locality.
Yes. CMS splits Maryland into 2 payment localities. For this CPT the office physician fee spans $3.23 from the lowest to highest locality. A ZIP lookup matters in Maryland because three different locality treatments are in play: check whether you fall in the Baltimore area, the DC suburbs like Bethesda and Silver Spring, or rest-of-state regions like Frederick, Hagerstown, and the Eastern Shore.
After the Part B deductible, coinsurance is usually 20% of the allowed amount: about $20 for the office physician line or $20 for the hospital physician line in Maryland. Medigap may cover that 20%. This is not the hospital facility fee.
No. $100.52 is the Medicare physician allowed amount for CPT 97162. Anesthesia, facility fees, implants, and other CPT codes billed the same day are extra. Maryland ranks #41 of 51 states on this physician line (3% above the national office rate of $97.86).