PT Evaluation (Moderate Complexity) Cost in Vermont
Pt eval mod complex 30 min
$97.24Vermont 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
Vermont Medicare physician rate (2026)
-0.6% vs nationalSingle statewide locality.
Your ZIP in Vermont
Enter a ZIP code for your part of Vermont, whether Burlington and Chittenden County, Montpelier, Rutland, Brattleboro, or the Northeast Kingdom.
What pt evaluation (moderate complexity) costs at hospitals near you
Everything above is a national average. The hospital you pick in Vermont 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 Vermont
Where Vermont ranks for this CPT
PT Evaluation (Moderate Complexity) and how Vermont is priced
Vermont, with the second-smallest population in the country, is priced as one statewide locality with indices close to the national average, higher than northern New England's rural profile might suggest. Burlington and the smallest Northeast Kingdom towns share the same Medicare-approved amounts. No subdivision has ever been warranted for a state without a single large metro. The fee schedule's simplicity contrasts with the real-world challenge of delivering specialty care across the Green Mountains.
The state's academic medical center in Burlington handles most complex care and also serves northern New York across Lake Champlain, while community hospitals cover the rest of the state with limited procedure menus. Vermonters in the south and east regularly use Dartmouth-area or Boston providers over the border. An aging population, among the oldest in the nation, keeps Medicare central to the state's health economy.
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 Vermont
PT Evaluation (Moderate Complexity) in other states
PT Evaluation (Moderate Complexity) in Vermont: questions
Vermont is a single Medicare locality for this fee schedule. The 2026 physician rate for CPT 97162 is $97.24 in an office and $97.24 in a hospital, statewide. A ZIP lookup still confirms the locality mapping.
Not on the physician fee schedule. Vermont 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 Vermont. Medigap may cover that 20%. This is not the hospital facility fee.
No. $97.24 is the Medicare physician allowed amount for CPT 97162. Anesthesia, facility fees, implants, and other CPT codes billed the same day are extra. Vermont ranks #27 of 51 states on this physician line (within 2% of the national office rate of $97.86).