Re-evaluation for physical therapy, typically 20 minutes
Medicare pricing data for 41,019 providers across 52 states
Note: These costs reflect the Medicare physician/supplier component. Hospital facility fees are billed separately and can be 2-5x the physician fee.
💡 What You Should Know
Re-evaluation for physical therapy, typically 20 minutes (HCPCS code 97164) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $69.37, but hospitals typically charge $117.66 — a 1.7x markup. Prices vary significantly by state and provider.
🏷️ Typical Out-of-Pocket Cost
Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $69.37, your out-of-pocket cost would be approximately $13.87. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.
What Hospitals Charge vs. What Medicare Pays
Hospitals charge 1.7x more than what Medicare allows for this procedure. Medicare actually pays $53.36 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Alaska | $86 | $171 | 137 | 740 | +24.2% |
| District of Columbia | $76 | $136 | 112 | 1,366 | +9.8% |
| New Jersey | $75 | $148 | 2,456 | 42,445 | +8.0% |
| New York | $74 | $125 | 3,201 | 37,755 | +6.0% |
| Maryland | $74 | $118 | 1,452 | 40,807 | +6.0% |
| California | $74 | $109 | 4,014 | 64,624 | +6.0% |
| Connecticut | $73 | $111 | 387 | 4,171 | +5.4% |
| Massachusetts | $73 | $125 | 1,114 | 17,598 | +5.0% |
| Hawaii | $72 | $97 | 298 | 4,392 | +3.3% |
| Washington | $70 | $106 | 1,356 | 10,971 | +1.0% |
| Colorado | $70 | $127 | 1,184 | 15,847 | +0.7% |
| Delaware | $70 | $114 | 273 | 4,580 | +0.7% |
| Rhode Island | $70 | $121 | 167 | 1,919 | +0.6% |
| Virginia | $69 | $112 | 1,040 | 13,341 | +0.2% |
| New Hampshire | $69 | $104 | 180 | 1,990 | +0.1% |
| Illinois | $69 | $115 | 1,777 | 13,839 | +0.1% |
| Oregon | $69 | $140 | 601 | 4,759 | -0.4% |
| Pennsylvania | $69 | $116 | 1,927 | 33,082 | -0.4% |
| North Dakota | $69 | $129 | 115 | 496 | -0.5% |
| Minnesota | $69 | $148 | 671 | 2,833 | -0.9% |
| Montana | $69 | $116 | 261 | 2,027 | -1.0% |
| Florida | $68 | $133 | 1,706 | 23,210 | -1.4% |
| Wyoming | $68 | $110 | 204 | 2,228 | -1.4% |
| South Dakota | $68 | $117 | 157 | 688 | -2.0% |
| Maine | $68 | $120 | 224 | 2,614 | -2.4% |
| Vermont | $67 | $91 | 147 | 2,314 | -2.8% |
| Arizona | $67 | $116 | 1,334 | 25,664 | -3.4% |
| Texas | $67 | $123 | 1,922 | 36,813 | -3.5% |
| Wisconsin | $66 | $133 | 675 | 3,752 | -4.3% |
| Puerto Rico | $66 | $74 | 98 | 927 | -4.9% |
| Indiana | $66 | $125 | 557 | 5,184 | -5.0% |
| Utah | $66 | $96 | 310 | 3,431 | -5.2% |
| Ohio | $66 | $121 | 879 | 12,050 | -5.5% |
| South Carolina | $65 | $97 | 514 | 6,699 | -5.7% |
| New Mexico | $65 | $106 | 156 | 1,968 | -5.7% |
| Iowa | $65 | $109 | 585 | 7,747 | -5.9% |
| Nebraska | $65 | $112 | 360 | 3,604 | -5.9% |
| Kansas | $65 | $97 | 377 | 3,803 | -6.1% |
| Missouri | $65 | $97 | 600 | 7,361 | -6.7% |
| Georgia | $64 | $103 | 1,027 | 6,865 | -7.3% |
| Oklahoma | $64 | $110 | 331 | 2,324 | -7.8% |
| West Virginia | $64 | $85 | 200 | 2,814 | -7.8% |
| Louisiana | $64 | $106 | 377 | 6,457 | -7.9% |
| Idaho | $64 | $89 | 311 | 2,686 | -7.9% |
| Kentucky | $64 | $116 | 462 | 6,877 | -8.4% |
| Tennessee | $64 | $106 | 907 | 8,442 | -8.4% |
| North Carolina | $63 | $106 | 1,290 | 13,178 | -8.6% |
| Arkansas | $63 | $101 | 246 | 2,385 | -9.3% |
| Alabama | $63 | $89 | 581 | 4,106 | -9.6% |
| Mississippi | $62 | $92 | 250 | 2,375 | -11.1% |
| Nevada | $58 | $118 | 357 | 4,663 | -16.4% |
| Michigan | $52 | $95 | 1,119 | 8,380 | -24.4% |
⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.
💊 Need post-procedure medications? Check costs on OpenPrescriber