Physical Therapy Evaluation (moderate complexity)

This is the first physical therapy appointment — the one where the therapist examines you and writes a plan, rather than treating you. It is the middle of three complexity tiers, so it reflects a presentation that was neither straightforward nor unusually involved.

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What it is

Before a physical therapist treats anything, there is an evaluation: a history, a hands-on examination, measurements of strength, range of motion, balance and function, and a written plan of care with goals. Since 2017 that evaluation has been billed at one of three complexity tiers rather than as a single flat code. This is the middle tier. The tier is chosen by the therapist based on how involved the case was — how much history there was to take, how many systems had to be examined, how stable the presentation was, and how much clinical judgment the plan required. It is not a measure of how severe the problem is or of how long the appointment ran.

Why it is done

To establish what is actually limiting movement or function, which is often not the same thing as where the pain is
To set measurable goals and a plan of care, which insurers generally require before they will pay for treatment visits
To record a baseline against which later progress is judged
To identify findings that belong to a physician rather than a therapist, and send the patient back

What to expect

The visit usually runs longer than a later treatment session. Expect questions about the history of the problem, prior injuries, other medical conditions and medications, and what you are trying to get back to doing. The examination is hands-on: the therapist will move the joint, test strength against resistance, watch you walk, and may use standardized scoring tools. Some treatment often happens in the same visit — a first set of exercises, or manual work — and that treatment is billed separately from the evaluation. Most people leave with a plan: how many visits are expected, what to do at home, and what the goals are.

Questions worth asking

Which of the three evaluation tiers is being billed, and does my plan pay a different amount for each?
Will treatment performed at this same visit be billed on top of the evaluation, and in what units?
Does my plan require a physician referral or prior authorization before therapy visits are covered, and does that apply to the evaluation itself?
Is there a visit limit for the year, and does this evaluation count against it?

What Physical Therapy Evaluation (moderate complexity) costs by state

Physical Therapy Evaluation (moderate complexity) cost in Texas — 120 hospitals, median $327.15
Physical Therapy Evaluation (moderate complexity) cost in Florida — 79 hospitals, median $615.24
Physical Therapy Evaluation (moderate complexity) cost in California — 66 hospitals, median $317.45
Physical Therapy Evaluation (moderate complexity) cost in Ohio — 63 hospitals, median $264.00
Physical Therapy Evaluation (moderate complexity) cost in Illinois — 51 hospitals, median $247.20
Physical Therapy Evaluation (moderate complexity) cost in Virginia — 43 hospitals, median $263.50
Physical Therapy Evaluation (moderate complexity) cost in Tennessee — 38 hospitals, median $77.85
Physical Therapy Evaluation (moderate complexity) cost in Wisconsin — 34 hospitals, median $240.00
Physical Therapy Evaluation (moderate complexity) cost in Pennsylvania — 33 hospitals, median $303.60
Physical Therapy Evaluation (moderate complexity) cost in Iowa — 31 hospitals, median $231.94
Physical Therapy Evaluation (moderate complexity) cost in Michigan — 27 hospitals, median $249.26
Physical Therapy Evaluation (moderate complexity) cost in Indiana — 26 hospitals, median $189.60
Physical Therapy Evaluation (moderate complexity) cost in Georgia — 25 hospitals, median $144.45
Physical Therapy Evaluation (moderate complexity) cost in Kentucky — 25 hospitals, median $268.80
Physical Therapy Evaluation (moderate complexity) cost in Washington — 25 hospitals, median $207.48
Physical Therapy Evaluation (moderate complexity) cost in New Jersey — 24 hospitals, median $126.19
Physical Therapy Evaluation (moderate complexity) cost in New York — 23 hospitals, median $111.81
Physical Therapy Evaluation (moderate complexity) cost in Arizona — 21 hospitals, median $87.99
Physical Therapy Evaluation (moderate complexity) cost in Missouri — 20 hospitals, median $207.90
Physical Therapy Evaluation (moderate complexity) cost in Minnesota — 19 hospitals, median $240.35
Physical Therapy Evaluation (moderate complexity) cost in Colorado — 17 hospitals, median $844.12
Physical Therapy Evaluation (moderate complexity) cost in Oklahoma — 17 hospitals, median $303.88
Physical Therapy Evaluation (moderate complexity) cost in West Virginia — 16 hospitals, median $216.50
Physical Therapy Evaluation (moderate complexity) cost in North Carolina — 15 hospitals, median $303.15
Physical Therapy Evaluation (moderate complexity) cost in Nebraska — 13 hospitals, median $107.10
Physical Therapy Evaluation (moderate complexity) cost in Oregon — 12 hospitals, median $297.75
Physical Therapy Evaluation (moderate complexity) cost in Kansas — 11 hospitals, median $110.00
Physical Therapy Evaluation (moderate complexity) cost in Mississippi — 11 hospitals, median $116.85
Physical Therapy Evaluation (moderate complexity) cost in South Carolina — 11 hospitals, median $302.00
Physical Therapy Evaluation (moderate complexity) cost in Arkansas — 8 hospitals, median $376.35
Physical Therapy Evaluation (moderate complexity) cost in Maine — 7 hospitals, median $357.65
Physical Therapy Evaluation (moderate complexity) cost in South Dakota — 7 hospitals, median $280.00
Physical Therapy Evaluation (moderate complexity) cost in Louisiana — 6 hospitals, median $66.82
Physical Therapy Evaluation (moderate complexity) cost in Alaska — 5 hospitals, median $543.66
Physical Therapy Evaluation (moderate complexity) cost in Nevada — 4 hospitals, median $165.26
Physical Therapy Evaluation (moderate complexity) cost in North Dakota — 4 hospitals, median $280.00
Physical Therapy Evaluation (moderate complexity) cost in Wyoming — 4 hospitals, median $155.48
Physical Therapy Evaluation (moderate complexity) cost in New Mexico — 3 hospitals, median $162.12
Physical Therapy Evaluation (moderate complexity) cost in Hawaii — 2 hospitals, median $127.68
Physical Therapy Evaluation (moderate complexity) cost in Maryland — 2 hospitals, median $182.40
Physical Therapy Evaluation (moderate complexity) cost in Montana — 2 hospitals, median $123.20
Physical Therapy Evaluation (moderate complexity) cost in New Hampshire — 1 hospitals, median $675.65

Physical Therapy Evaluation (moderate complexity) prices at hospitals

See every published price for Physical Therapy Evaluation (moderate complexity): the full national range, the state and hospital breakdowns, and which hospitals charge the least.

Physical Therapy Evaluation (moderate complexity) cost — see all prices →

Sources

APTA: Tiered Physical Therapy Evaluation and Reevaluation CPT Codes (opens in a new tab, leaves healthcosts.net)
MedlinePlus: Physical medicine and rehabilitation (opens in a new tab, leaves healthcosts.net)
Wikipedia (opens in a new tab, leaves healthcosts.net)

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