Is CPT 97161 overcharged?
97161: Physical therapy evaluation, low complexity (Physical therapy)
Approximate Medicare national rate
$97.86
Source: CMS Physician Fee Schedule CY2026, Oct release (national, non-facility). National amount; actual Medicare payment varies by locality. Facility-setting physician rate: $97.86 (hospital facility fee billed separately).
What's a reasonable charge?
Commercial insurers typically pay roughly 1.5 to 2.5 times Medicare. If you were billed more than $293.58 for 97161, ask for an itemized bill, request the provider's cash price, and dispute the difference.
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Duplicates and unbundling are often worth more than a single high price. Scan your bill free