PT Evaluation (Low Complexity) Cost in South Dakota
Pt eval low complex 20 min
$97.64South Dakota 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 Dakota Medicare physician rate (2026)
-0.2% vs nationalSingle statewide locality.
Your ZIP in South Dakota
Try a ZIP lookup for your area, whether Sioux Falls, Rapid City and the Black Hills, Aberdeen, Pierre, or the reservation and ranch country in between.
What pt evaluation (low complexity) costs at hospitals near you
Everything above is a national average. The hospital you pick in South Dakota 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 Dakota
Where South Dakota ranks for this CPT
PT Evaluation (Low Complexity) and how South Dakota is priced
All of South Dakota falls under a single payment locality with indices near the bottom of the national scale, cushioned by the work index floor for low-cost states. Sioux Falls and a West River ranch community share one published fee schedule. The state's east-west split, with most people and providers east of the Missouri River, has no counterpart in the pricing structure. That leaves South Dakota with some of the simplest and lowest Medicare pricing in the country.
Sioux Falls has become a genuine regional medical hub, headquarters to large systems whose reach extends across the Dakotas and into neighboring states, while Rapid City anchors care for the West River side and the Black Hills. Vast stretches between them rely on critical access hospitals and tribal facilities, some of the most isolated care settings in America. Referrals to Sioux Falls, Rapid City, or out of state are a routine part of rural care.
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 Dakota
PT Evaluation (Low Complexity) in other states
PT Evaluation (Low Complexity) in South Dakota: questions
South Dakota is a single Medicare locality for this fee schedule. The 2026 physician rate for CPT 97161 is $97.64 in an office and $97.64 in a hospital, statewide. A ZIP lookup still confirms the locality mapping.
Not on the physician fee schedule. South Dakota 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 $20 for the office physician line or $20 for the hospital physician line in South Dakota. Medigap may cover that 20%. This is not the hospital facility fee.
No. $97.64 is the Medicare physician allowed amount for CPT 97161. Anesthesia, facility fees, implants, and other CPT codes billed the same day are extra. South Dakota ranks #31 of 51 states on this physician line (within 2% of the national office rate of $97.86).