Physical therapy cost per visit: the codes, the 15-minute units and the Medicare anchors
A physical therapy visit is priced as a stack of timed codes, one unit per 15 minutes, not as one fee. On Medicare's 2026 schedule in Detroit, a first visit with an evaluation and two units of activity training is $146.34, and a follow-up of four units across three codes is $100.21, after the same-day reduction that Medicare applies to the practice-expense part of every unit after the first. Those are Medicare anchors, not clinic prices, and no verified self-pay price exists, so the clinic's written price list by code is the number to get.
Prices only. This page says nothing about what treatment anyone needs or how many visits are right, and the visit shapes below are examples chosen for arithmetic. If you are paying yourself, ask the clinic for its price by code and unit, and confirm your price in writing before service.
A visit is a stack of codes
The bill for a treatment visit lists each procedure the therapist performed, with a unit count, and the codes come from the same family regardless of the setting. The codes below are the ones that appear on most outpatient physical therapy claims, with Medicare physician fee schedule amounts for 2026 in Michigan Locality 01 (Detroit). They are computed from the CMS October 2026 release of the relative value file and its geographic indexes, the same method as the other anchors on this site, and the evaluation and treatment rates are the same in an office and in a hospital outpatient department.
| Code | CMS descriptor | Billed as | Anchor per unit or service |
|---|---|---|---|
| 97161, 97162, 97163 | PT evaluation, low, moderate, high complexity | Once per evaluation | $96.48 each |
| 97164 | PT re-evaluation | Once per re-evaluation | $66.47 |
| 97110 | Therapeutic exercises | Per 15 minutes | $28.81 |
| 97112 | Neuromuscular reeducation | Per 15 minutes | $32.41 |
| 97116 | Gait training | Per 15 minutes | $28.81 |
| 97124 | Massage therapy | Per 15 minutes | $29.34 |
| 97140 | Manual therapy, one or more regions | Per 15 minutes | $27.50 |
| 97530 | Therapeutic activities | Per 15 minutes | $34.60 |
| 97035 | Ultrasound, one or more areas | Per 15 minutes | $14.35 |
| 97012 | Mechanical traction | Per visit | $14.38 |
| 97150 | Group therapeutic procedures | Per session | $17.99 |
| G0283 | Electrical stimulation, other than wound | Per visit | $12.70 |
The table is the price vocabulary of a therapy clinic. A price list that says "treatment visit" without codes is a price list that cannot be compared with anything. The single largest line in most visits is the exercise or activity code, so the number of units on it matters more to the total than whether a short add-on appears. For the evaluation, the guide on physical therapy evaluation pricing gives the layers on the first visit.
How minutes become units
Medicare's counting rule for timed codes is in chapter 5, section 20.2, of the Claims Processing Manual. It says that when only one service is provided in a day, providers should not bill for less than 8 minutes, and that for a single timed code in the same day a unit is billed for at least 8 and up to 22 minutes. The manual's table for the full range reads:
| Total timed minutes in the day | Units that can be billed |
|---|---|
| 8 through 22 | 1 |
| 23 through 37 | 2 |
| 38 through 52 | 3 |
| 53 through 67 | 4 |
| 68 through 82 | 5 |
| 83 through 97 | 6 |
When more than one timed code is performed on the same day, the manual says the total number of minutes of service determines the number of timed units billed, and that the units are constrained by that total. Section 20.3 adds what counts as time: the time counted begins when the therapist, or an assistant under supervision, is directly working with the patient to deliver treatment, and the patient should already be in the treatment area and ready to begin. Time spent resting, toileting or waiting for equipment is not billed. For a patient, the useful reading is that a "one-hour visit" is not 4 units by default. It is as many units as the minutes of hands-on treatment support, and a visit with 40 minutes of direct treatment bills 3 units even if the patient was in the building for an hour. A commercial plan's contract may count units differently, so the question for a cash patient is which counting rule the clinic uses.
The same-day reduction
Medicare applies a multiple procedure payment reduction to the practice-expense part of therapy payments. Section 10.7 of the same manual says full payment is made for the unit or procedure with the highest practice-expense payment. For every subsequent unit or procedure furnished to the same patient on the same day, full payment is made for work and malpractice, and 50 percent of the practice-expense portion is paid. The reduction applies to multiple units as well as multiple procedures, and it counts all therapy services for the patient that day regardless of discipline. The reduced amount is also the one used to calculate the patient's coinsurance and deductible.
Here is what that does to the per-unit anchors. The work and malpractice share is fixed, the practice-expense share is halved after the first unit.
| Code | Full amount, first unit | Work plus malpractice | Practice expense | Each later unit that day |
|---|---|---|---|---|
| 97161 evaluation | $96.48 | $52.00 | $44.48 | $74.24 |
| 97530 activities | $34.60 | $15.26 | $19.34 | $24.93 |
| 97110 exercises | $28.81 | $15.59 | $13.22 | $22.20 |
| 97140 manual therapy | $27.50 | $14.93 | $12.57 | $21.21 |
| 97035 ultrasound | $14.35 | $7.58 | $6.77 | $10.96 |
Contractors rank the services by practice-expense value and pay the highest at 100 percent, so on a visit with exercises and activities, the first unit of activities, with the higher practice-expense value of 0.60 against 0.41 for exercises, is the one paid in full. The component amounts are rounded to the cent from the file, and a contractor's remittance can differ from a hand calculation by a cent or two.
Three visits priced on the anchors
The three visits below are shapes, not recommendations. Each lists the units, the ranking that sets which unit is paid in full, the Medicare allowed amount after the reduction, and for comparison the amount without it.
| Visit shape (Detroit, 2026) | Lines | Allowed with the reduction | Without the reduction | 20% coinsurance after the deductible |
|---|---|---|---|---|
| First visit: an evaluation plus two units of activities (about 30 timed minutes) | 97161 once at $96.48; 97530 two units at $24.93 each | $146.34 | $165.68 | $29.27 |
| Follow-up, 55 timed minutes, 4 units | 97530 one unit at $34.60; 97110 two units at $22.20; 97140 one unit at $21.21 | $100.21 | $119.72 | $20.04 |
| Short follow-up, 20 timed minutes, 1 unit | 97110 one unit at $28.81 | $28.81 | $28.81 | $5.76 |
In the first row, the 97530 unit is paid at the reduced $24.93 because the evaluation has the highest practice-expense value and is paid in full. The second row shows the reduction at work: three of the four units are paid with half of their practice-expense share, which takes $19.51 off the unreduced $119.72. The third row shows that a visit of one unit never meets the reduction. The coinsurance column assumes the Part B deductible of $283 for 2026 has already been met; the first claims of the year bear the full allowed amount until it is.
Where you live and where the visit happens
The fee schedule scales each code by the locality's geographic indexes, so the same code is a different number in different places. Four codes in eight localities, for the office or the hospital outpatient department alike, show the range for 2026.
| Locality | 97110 | 97140 | 97530 | 97161 |
|---|---|---|---|---|
| Arkansas | $26.97 | $25.72 | $32.08 | $91.20 |
| Alabama | $27.20 | $25.95 | $32.42 | $91.96 |
| Ohio | $27.87 | $26.59 | $33.33 | $93.86 |
| Detroit | $28.81 | $27.50 | $34.60 | $96.48 |
| Houston | $29.21 | $27.87 | $35.17 | $98.08 |
| Miami | $30.13 | $28.77 | $36.40 | $100.27 |
| Manhattan | $32.43 | $30.95 | $39.45 | $108.82 |
| San Francisco | $35.91 | $34.24 | $44.49 | $121.46 |
These therapy codes have the same practice-expense value in an office and in a facility setting, so unlike an office visit, there is no separate facility column. The reason is in how Medicare pays for the care. The manual says the physician fee schedule is the payment method for outpatient rehabilitation services, and it names two exceptions: critical access hospitals, paid on reasonable cost, and Maryland hospitals, paid under the Maryland All-Payer Model. In the October 2026 hospital outpatient addendum, the main therapy codes carry status A, which CMS's status indicator tables define as not paid under the hospital outpatient system but under a fee schedule or payment system other than it. That is a Medicare payment fact. A hospital that runs a therapy department can still set its own self-pay price list, and the guide on facility fees explains why a hospital's list may differ from a clinic's.
Checking the unit count on a bill
The counting table gives a patient a simple test that needs no knowledge of the codes. Total the billed units across all timed codes, ask the clinic for the total timed minutes, and compare. The rows below are invented bills tested against Medicare's table.
| Total timed minutes recorded | Timed units billed | Units the table allows | Reading |
|---|---|---|---|
| 38 | 3 | 3 (38 to 52) | Consistent |
| 20 | 2 | 1 (8 to 22) | One unit more than the minutes support; ask for the record |
| 55 | 4 | 4 (53 to 67) | Consistent |
| 90 | 7 | 6 (83 to 97) | One unit more than the minutes support |
| 6 | 1 | 0 (under 8) | Below the minimum for a unit when only one service is provided |
A mismatch is not proof of an error, since the minutes recorded and the minutes the patient remembers can differ, and a clinic may count by a commercial payer's rule. It is a reason to ask for the treatment note, which under the same manual must document the total timed minutes. The manual also says the expectation, based on the work values of these codes, is that direct patient contact per unit averages 15 minutes, and that a consistent practice of billing less than 15 minutes per unit should be reviewed. Where two clinicians are needed to treat one patient at the same time, each 15 minutes of patient treatment still counts as one unit, so a second pair of hands does not double the bill.
Two disciplines on one day
The same-day reduction does not care which discipline billed the service. Section 10.7 says Medicare applies the reduction to all therapy services furnished to a patient on the same day, regardless of whether they are provided in one therapy discipline or several, such as physical therapy, occupational therapy or speech-language pathology. Take an invented day with two units of therapeutic exercise (97110) from a physical therapist and one unit of therapeutic activities (97530) from an occupational therapist. The activities unit has the highest practice-expense value, so it is paid in full at $34.60, and the two exercise units are paid at the reduced $22.20 each, for $79.00. Billed separately on different days, the same three units would be $28.81 times two plus $34.60, or $92.22. The $13.22 difference is the reduction, and it appears because the visits fell on one date.
The same follow-up visit in eight localities
The locality table above gives per-unit amounts. Applied to the two visit shapes, with the first unit of activities paid in full and the rest reduced, the totals move as follows.
| Locality | First visit: evaluation plus two units of activities | Follow-up: four units, three codes |
|---|---|---|
| Arkansas | $138.16 | $94.37 |
| Alabama | $139.26 | $95.09 |
| Ohio | $142.22 | $97.22 |
| Detroit | $146.34 | $100.21 |
| Houston | $148.52 | $101.39 |
| Miami | $152.21 | $104.39 |
| Manhattan | $164.44 | $111.79 |
| San Francisco | $182.18 | $122.04 |
The follow-up visit anchor spans $27.67 from Arkansas to San Francisco. That spread is the Medicare locality effect. The Medicare figure is a yardstick, and the clinic's written price is the answer.
Assistants, hot packs and the annual threshold
Three other features of Medicare's therapy rules reach the bill. First, services furnished in whole or in part by a physical therapist assistant or an occupational therapy assistant, reported with the CQ or CO modifiers, are paid at 85 percent of the otherwise applicable amount, per CMS. Second, some codes that patients associate with therapy are not paid as separate services. The hot or cold pack code 97010 carries status B, bundled, in the 2026 file, and attended electrical stimulation 97014 carries status I, not valid for Medicare, with Medicare's G0283 used instead at $12.70. A clinic that bills codes in addition to the ones Medicare pays is following its own price list, and it should say which. Third, CMS publishes a KX modifier threshold for each calendar year, $2,480 for 2026 for physical therapy and speech-language pathology combined and the same for occupational therapy.
A per-unit price list against a flat per-visit price
A cash patient may be offered either a list of prices by unit or a flat price per visit, and the right comparison depends on how many units the visits usually bill. The prices here are invented: the clinic charges $35 per timed unit and also offers a flat $90 per visit that includes up to three timed units and any modalities.
| Timed units in the visit | Per-unit price list | Flat $90 visit |
|---|---|---|
| 1 | $35 | $90 |
| 2 | $70 | $90 |
| 3 | $105 | $90 |
| 4 | $140 | Not stated: ask whether a fourth unit is extra |
On those prices the per-unit list is lower for visits of one or two units and the flat price is lower at three, which is why the answer to "which is the better deal" is a question about the visit shape and not about the clinic. The question to put to the clinic is what the flat price assumes: the number of units, the codes, whether an evaluation is separate, and what happens when a visit runs short or long. A patient with insurance faces a different version of the same comparison. If the plan charges a $40 copayment per therapy visit regardless of the allowed amount, twelve visits are $480, and a deductible, if it applies to therapy, changes the early visits. The guide on paying cash and your deductible works that comparison through at several deductible states.
How fast the $2,480 marker arrives, by visit shape
Because the threshold is counted in allowed dollars after the same-day reduction, the number of visits it takes to reach it depends on the visit shape. At Detroit's 2026 amounts, the arithmetic is as follows.
| Visit shape | Allowed per visit | Visits to pass $2,480 |
|---|---|---|
| One unit of therapeutic exercise (97110) | $28.81 | The 87th visit ($2,480 divided by $28.81 is 86.08) |
| Two units: one of 97110 and one of 97140 | $50.02 | The 50th visit (49.58) |
| Four units across 97530, 97110 and 97140 | $100.21 | The 25th visit (24.75) |
The takeaway is not a prediction. It is that the threshold is a function of billing intensity, so two patients with the same number of visits can be on different sides of it. A patient who is near it should ask the provider for the year-to-date therapy total in allowed dollars rather than count visits. Medicare.gov says a provider must certify that therapy is needed and describes the benefit as having no limit on what Medicare pays for medically necessary outpatient therapy in a calendar year.
For a patient with a commercial plan or a Medicare Advantage plan, the plan's own rules replace the Medicare marker. Four questions get the plan side in writing: is therapy covered, and is there a limit on the number of visits in a year; is the cost sharing a copayment per visit or coinsurance on the allowed amount; does the deductible apply to therapy visits; and is prior authorization required before the first visit or after a set number of visits. The guide on prior authorization explains how to find out and what to do with the answer.
Getting a cash price in the same terms
- Ask for the price of the initial evaluation, and whether it includes any treatment on the same day.
- Ask for the price per 15-minute unit of the codes the clinic uses most, such as 97110, 97140 and 97530, and whether the price is the same for each.
- Ask how the clinic counts units: by total timed minutes, or by minutes per code.
- Ask whether modalities such as ultrasound, traction or stimulation are billed separately, and what they cost.
- Ask whether a flat per-visit or package price exists, what it includes, and what happens if a visit is shorter.
- Ask for the answers by message or email, with the date, before the first appointment.
For a scheduled service, a person who does not use insurance is entitled to a written Good Faith Estimate, which is covered in the guide on Good Faith Estimates. The guide on how to ask for the cash price adds wording for the call, and the guide on questions to ask billing before a procedure covers the remaining layers.
Pricing a plan of care in arithmetic
Therapy clinics often describe a course of visits rather than a single visit, and the course is what a patient pays for. Use stated inputs: one first visit and eleven follow-ups of the shape above, which is twelve visits, as pure arithmetic with no view on the right number. The Medicare allowed total is $146.34 plus 11 times $100.21, or $1,248.65. If the Part B deductible of $283 is unmet at the start, the patient pays $283 plus 20 percent of the remaining $965.65, which is $193.13, for $476.13. If the deductible is already met, the patient's share is 20 percent of $1,248.65, which is $249.73. The two totals differ by $226.40, and the difference is entirely the deductible.
A person who is not on Medicare is not subject to these amounts. The quotation for a cash patient is whatever the clinic's price list says, and the useful step is to turn it into the same table: price per code, units for each visit, and what is included.
Physical therapy billing: questions patients ask
Is the initial evaluation billed separately from the treatment?
Yes. The evaluation has its own codes, 97161, 97162 and 97163 for the three complexity levels, and treatment minutes on the same day are billed under separate timed codes. In the 2026 file all three evaluation codes carry the same Detroit anchor of $96.48, so the complexity level does not move the Medicare amount. A first-visit bill therefore has an evaluation line and, if treatment happened, one or more treatment lines.
Why does a one-hour visit show up as several lines?
Because therapy is billed by the procedure and the 15-minute unit. A visit with exercise, manual work and activity training has one line for each code, with a unit count on each. The units across all timed codes are limited by the total timed minutes that day, so the lines add up to at most the units those minutes allow.
Does Medicare limit how much physical therapy it pays for in a year?
Medicare.gov says there is no limit on how much Medicare pays for medically necessary outpatient therapy services in one calendar year. CMS publishes a KX modifier threshold of $2,480 for 2026 for physical therapy and speech-language pathology combined, with the same figure for occupational therapy, so that figure is not a payment ceiling.
Are hot packs and electrical stimulation billed the same way?
Not under Medicare. In the 2026 file the hot or cold pack code 97010 carries status B, which means payment is bundled into other services, and the attended electrical stimulation code 97014 carries status I, not valid for Medicare, with Medicare using G0283 at $12.70 in Detroit instead. A cash patient's clinic may bill any of them separately, so the question is which codes are on the price list.
Do therapists' assistants change the Medicare amount?
CMS says services furnished in whole or in part by a physical therapist assistant or occupational therapy assistant, reported with the CQ or CO modifiers, are paid at 85 percent of the otherwise applicable fee schedule amount, effective January 1, 2022. A patient whose visit was with an assistant should expect an allowed amount below the full anchor on that line.
Is there a typical self-pay price per visit?
No verified one. No public source read for this page meets this site's verification rule for a self-pay range. What can be verified is the Medicare amount for each code and unit. The clinic's own written price list, with codes and unit counts, is the figure to get.
Files, rules and dates
CMS, Physician Fee Schedule relative value files RVU26D (October 2026 release, PPRRVU2026_Oct_nonQPP, released August 26, 2026) and GPCI2026, https://www.cms.gov/files/zip/rvu26d-updated-08-26-2026.zip, read October 23, 2026. Medicare Claims Processing Manual, chapter 5, sections 10.7 (multiple procedure payment reductions), 20.2 (reporting of service units) and 20.3 (what time counts), and the payment-system discussion at the start of the chapter, https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/clm104c05.pdf, read October 23, 2026. CMS, Therapy Services page (CY2026 KX modifier threshold $2,480 for PT and SLP combined and $2,480 for OT; 85 percent payment for services furnished in whole or in part by assistants; MPPR 50 percent), https://www.cms.gov/medicare/billing/therapyservices, read October 23, 2026. Medicare.gov, Physical therapy services (20 percent after the deductible; no limit on how much Medicare pays for medically necessary outpatient therapy in a year), https://www.medicare.gov/coverage/physical-therapy-services, read October 23, 2026. CMS, OPPS October 2026 Addendum B (updated October 14, 2026), status indicator A for 97110, 97140, 97530 and 97161, read October 23, 2026. The Part B deductible of $283 is from the CMS 2026 premiums and deductibles fact sheet.