Physical therapy evaluation: how much does Medicare pay?

Nationally, the Q3 2026 Physician Fee Schedule pays $97.86 in an office (non-facility) setting and $97.86 in a facility setting for 97161. Your local amount differs — the national figure applies geographic index values of 1.000, and Medicare then pays 80% of the allowed amount after the deductible is met.

Procedure · Updated Aug 1, 2026

Physical therapy evaluation: CPT code and Medicare rate

The initial assessment at a first physical therapy visit. 97161 is the low-complexity evaluation; 97162 applies when other medical problems complicate the picture.

Also called: pt evaluation, physical therapy assessment, first physical therapy visit.

Usually billed as

97161 Physical Therapy Evaluation, Low Complexity

Office (non-facility): $97.86
Facility: $97.86

National amounts for the Q3 2026 release (July 1 – September 30, 2026), using geographic index values of 1.000. Your local rate differs — open the code page for the locality breakdown.

The evaluation is billed once at the start of care. Treatment at later visits uses separate procedure codes.

Related codes

Codes worth checking before you settle on 97161.

Code	What it covers	Office	Facility
97162	Physical Therapy Evaluation, Moderate Complexity	$97.86	$97.86

A dash means the code has no national amount in this release — it may be carrier-priced, bundled, or not separately payable. That is never the same as $0.

Common questions

Physical therapy evaluation: which code is it?: 97161 — Physical Therapy Evaluation, Low Complexity. The initial assessment at a first physical therapy visit. 97161 is the low-complexity evaluation; 97162 applies when other medical problems complicate the picture.
Physical therapy evaluation: how much does Medicare pay?: Nationally, the Q3 2026 Physician Fee Schedule pays $97.86 in an office (non-facility) setting and $97.86 in a facility setting for 97161. Your local amount differs — the national figure applies geographic index values of 1.000, and Medicare then pays 80% of the allowed amount after the deductible is met.
Physical therapy evaluation: what else affects the billing?: The evaluation is billed once at the start of care. Treatment at later visits uses separate procedure codes.

Need the rate where you practice?

Every code page carries the full locality breakdown, the RVU and GPCI inputs, and the release that answered.

Open the code page

Keep exploring

All procedures How Medicare pays Office vs. facility rates Check a medical bill

This page maps everyday language to the code a claim normally carries. It is general information about how Medicare prices a service, not coding advice for a specific claim — the correct code always depends on what was actually documented and performed.

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