There is no single price: what you pay for a physical therapy evaluation depends on whether you use insurance, how much of your deductible is left, your copay or coinsurance, and whether the practice is a private office or a hospital department that adds a facility fee. With Original Medicare in 2026, you pay the $283 Part B deductible first and then usually 20 percent of the Medicare-approved amount. Self-pay prices are set by each practice, and if you are not using insurance you have a federal right to a written good faith estimate before the visit.
Last reviewed By the Monon Therapy Collective editorial team
What exactly is billed for a physical therapy evaluation?
An initial evaluation is billed with one of three procedure codes, 97161, 97162 or 97163, chosen by complexity: how many health factors affect your care, how much of the body is involved and how stable your presentation is. Your therapist picks the code from what they find, not from what you booked.
Treatment given on the same day, such as therapeutic exercise or manual therapy, can be billed separately in addition to the evaluation code. A re-evaluation later in your plan has its own code, 97164. Asking whether treatment will happen at the first visit tells you whether to expect one line on the bill or several.
Evaluations also vary in length. Some practices book a full hour for the first visit and others book less, and that time affects how much treatment fits in alongside the examination. The page on how long a physical therapy session lasts covers typical ranges.
What will I pay for the evaluation if I use private insurance?
You pay whatever your plan’s cost sharing says for an outpatient therapy visit. If you have not met your deductible, you may pay the full contracted rate for the evaluation. After the deductible, you pay a flat copay or a percentage coinsurance, and some plans charge a specialist-level copay for therapy.
Contracted rates differ by insurer and by practice, which is why two people with the same diagnosis can see different bills. Your insurer’s cost estimator, or a call to member services with the codes above, gives the most reliable figure. The page on copay versus coinsurance explains how each works on a therapy bill.
- How much of my deductible is left this year?
- Is outpatient physical therapy a copay or coinsurance, and how much?
- Do I need a referral or prior authorization for the evaluation to be covered?
- Is this practice in my plan’s network?
How does Medicare price a physical therapy evaluation in 2026?
Original Medicare covers a physical therapy evaluation under Part B. In 2026 you pay the first $283 of Part B costs for the year, then usually 20 percent of the Medicare-approved amount, with Medicare paying the rest. A Medigap policy may pick up some or all of that 20 percent.
The Medicare-approved amount comes from the Physician Fee Schedule and is adjusted by location, so Indianapolis-area rates differ from national figures. You can look up the codes 97161 to 97163 for your area with CMS’s free Physician Fee Schedule Look-Up Tool. Medicare Advantage plans set their own copays. The page on Medicare physical therapy coverage covers the rest of the Part B rules.
If you have a Medicare Advantage plan, the evaluation may come with a fixed copay instead of 20 percent, and the plan may require a referral or prior authorization first. Check the plan’s evidence of coverage or call the number on your card before booking.
What does a physical therapy evaluation cost without insurance?
Each practice sets its own self-pay price, so the only reliable figure is the one the practice gives you in writing. Some charge the evaluation as a single flat fee; others charge by the time spent or by the services delivered. Ask whether the price includes treatment on the same day.
If you are uninsured or choose not to use insurance, federal law gives you the right to a good faith estimate before the visit, and you can use the independent FAIR Health consumer site to see typical charges for the evaluation codes in your ZIP code. The self-pay physical therapy page and the explainer on good faith estimates go further.
Why can an evaluation cost more at a hospital-based clinic?
Outpatient therapy departments owned by a hospital can bill a facility fee in addition to the professional fee, while independent private practices generally do not. The same evaluation may therefore produce two charges in one setting and one in the other.
Ask any practice directly whether a facility fee applies before you book. Therapists in this network are independent practices working in private suites at Carmel City Center; each sets its own prices and verifies your benefits. The matching team asks about your plan and proposes a therapist whose office works with it where possible, and the cost and insurance page explains the rest.
Questions about price are routine for a therapist’s front office, and asking before the evaluation is far easier than disputing a bill afterward. Write down who you spoke to and what they quoted.
Related questions
Is the first physical therapy visit more expensive than later visits?
Often it is, because the evaluation is a longer, separately coded service. Follow-up visits are billed by the treatments delivered.
Does a higher-complexity evaluation code mean a bigger bill?
Not necessarily. Ask your insurer or the practice how the three evaluation codes are priced under your plan, because payment rules differ between payers.
Can I get a free physical therapy evaluation?
Be cautious with that offer, especially on Medicare, where routine free services and waived cost sharing raise legal issues. A free phone conversation about whether therapy is a fit is different from a clinical evaluation.
Can I use an HSA or FSA for a physical therapy evaluation?
Generally yes, because physical therapy for a medical problem is a qualified medical expense. The page on HSA and FSA spending has the detail.
Why did a bill for my evaluation arrive weeks later?
Insurers process the claim first, then the practice bills you for whatever the plan did not pay, such as deductible or coinsurance. Compare that bill with your explanation of benefits.
Keep reading
- How much does physical therapy cost without insurance?
- How much does physical therapy cost with insurance?
- How much does physical therapy cost with Medicare?
- What is a good faith estimate for physical therapy?
- How cost and insurance work for physical therapy
- Self-pay physical therapy in Carmel
- Using an HSA or FSA for physical therapy
Sources
This page is general education, not medical advice. A physical therapist can only advise on your situation after an examination.
