PT Evaluation (Low Complexity) Cost in South Carolina
Pt eval low complex 20 min
$94.31South Carolina 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
South Carolina Medicare physician rate (2026)
-3.6% vs nationalSingle statewide locality.
Your ZIP in South Carolina
Check your ZIP code for your region of South Carolina, whether Charleston and the Lowcountry, Columbia and the Midlands, Greenville-Spartanburg in the Upstate, or Myrtle Beach and the Grand Strand.
What pt evaluation (low complexity) costs at hospitals near you
Everything above is a national average. The hospital you pick in South Carolina 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 South Carolina
Where South Carolina ranks for this CPT
PT Evaluation (Low Complexity) and how South Carolina is priced
South Carolina prices through one statewide locality with indices a bit below the national average, so Charleston, Columbia, Greenville, and the rural Pee Dee share the same Medicare-approved amounts. Rapid coastal growth has not led CMS to break out a separate locality, keeping the fee schedule uniform from the mountains to the sea islands. The single set of adjustments makes the statewide figures here directly usable anywhere in the state. Facility fees at hospital-owned locations remain the largest source of price variation for patients.
The state's medical firepower splits three ways: an academic medical center and strong hospital market in Charleston, the capital-region systems in Columbia, and a large Upstate network centered on Greenville. Retiree-heavy coastal areas like Hilton Head and Myrtle Beach have booming demand for Medicare-age care, while the rural I-95 corridor faces some of the state's worst access gaps. Some border residents use Charlotte or Augusta providers.
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 South Carolina
PT Evaluation (Low Complexity) in other states
PT Evaluation (Low Complexity) in South Carolina: questions
South Carolina is a single Medicare locality for this fee schedule. The 2026 physician rate for CPT 97161 is $94.31 in an office and $94.31 in a hospital, statewide. A ZIP lookup still confirms the locality mapping.
Not on the physician fee schedule. South Carolina 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 South Carolina. Medigap may cover that 20%. This is not the hospital facility fee.
No. $94.31 is the Medicare physician allowed amount for CPT 97161. Anesthesia, facility fees, implants, and other CPT codes billed the same day are extra. South Carolina ranks #16 of 51 states on this physician line (4% below the national office rate of $97.86).