PT Evaluation (Moderate Complexity) Cost in New Mexico
Pt eval mod complex 30 min
$94.11New Mexico 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
New Mexico Medicare physician rate (2026)
-3.8% vs nationalSingle statewide locality.
Your ZIP in New Mexico
Enter your ZIP code for local context, whether Albuquerque, Santa Fe, Las Cruces, Farmington, Roswell, or the rural pueblos and high desert in between.
What pt evaluation (moderate complexity) costs at hospitals near you
Everything above is a national average. The hospital you pick in New Mexico 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 New Mexico
Where New Mexico ranks for this CPT
PT Evaluation (Moderate Complexity) and how New Mexico is priced
A single statewide locality covers New Mexico, with geographic indices below the national average, so Albuquerque, Santa Fe, and the most remote high-desert communities share one set of Medicare-approved amounts. The state benefits from the floor CMS applies to the physician work index, which lifts low-cost states toward parity. Uniform pricing across a state this large and sparse means the fee schedule is the easy part; finding a provider is often the harder one. Las Cruces and the border region price identically to the Albuquerque metro.
Albuquerque holds the state's academic medical center and most of its specialists, and for many New Mexicans it is the only in-state option for advanced procedures. The Indian Health Service and tribal facilities are central to care across large parts of the state. Residents of the southeast often use Texas providers in Lubbock or El Paso, and northern communities sometimes look to Colorado.
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 New Mexico
PT Evaluation (Moderate Complexity) in other states
PT Evaluation (Moderate Complexity) in New Mexico: questions
New Mexico is a single Medicare locality for this fee schedule. The 2026 physician rate for CPT 97162 is $94.11 in an office and $94.11 in a hospital, statewide. A ZIP lookup still confirms the locality mapping.
Not on the physician fee schedule. New Mexico 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.
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 New Mexico. Medigap may cover that 20%. This is not the hospital facility fee.
No. $94.11 is the Medicare physician allowed amount for CPT 97162. Anesthesia, facility fees, implants, and other CPT codes billed the same day are extra. New Mexico ranks #15 of 51 states on this physician line (4% below the national office rate of $97.86).