Physical therapy reimbursement is set per CPT code, not per visit. Evaluations (97161–97163) pay a flat per-visit amount; treatment codes like 97110 and 97140 pay per 15-minute timed unit under the 8-minute rule. Commercial rates are a negotiated percentage of the Medicare Physician Fee Schedule, and they vary by payer, locality, and contract.
No commercial payer publishes a PT fee schedule on a public pricing page, so most physical therapists sign contracts without knowing whether the numbers are good. The rates exist in public data anyway: every payer posts contracted amounts in machine-readable Transparency in Coverage files, and Medicare publishes its fee schedule to the penny.
What do commercial payers pay for physical therapy?
A negotiated percentage of Medicare, applied code by code. Aetna, Anthem, Cigna, and UnitedHealthcare each price 97110, 97140, and the evaluation codes separately in your contract, and the spread inside one network is wide: Transparency in Coverage filings show the same code paying some clinics well above the Medicare amount and others below it, in the same state.
That spread is the important fact. Which payer logo is on the card matters less than which contract you signed, when you signed it, and where you practice. To see the contracted ranges for your own area, run the reimbursement calculator: pick physical therapy, enter your ZIP code and email, and you get a payer-by-payer report for Aetna, Anthem, Cigna, and UnitedHealthcare built from those same filings. The published national and state figures are also on the per-code rate pages: 97110, therapeutic exercise and 97161, the PT evaluation, with every code indexed from the rate guides hub.
How does physical therapy billing work?
Almost everything you bill is either an untimed code, paid once per visit, or a timed code, paid per 15-minute unit. The evaluation codes 97161, 97162, and 97163 are untimed: whether the eval takes 25 minutes or 55, it pays one flat amount. Treatment codes like therapeutic exercise are timed, so the minutes you document decide the units you bill.
Medicare counts timed units with the 8-minute rule. Total your timed minutes across the visit, then bill one unit at 8 minutes and another at each 15-minute step after that:
| Total timed minutes | Billable units |
|---|---|
| 8–22 | 1 |
| 23–37 | 2 |
| 38–52 | 3 |
| 53–67 | 4 |
Many commercial payers follow Medicare's counting; others apply the AMA convention, which counts each code's minutes separately instead of totaling across codes. The difference sounds academic until a 40-minute visit yields three units under one method and two under the other. Your contract, or the payer's provider manual, states which method applies.
Which CPT codes drive PT reimbursement?
Five codes carry most outpatient PT revenue. The evaluations pay per visit at one of three complexity levels, and the treatment codes pay per unit:
| CPT code | Service | Paid as |
|---|---|---|
| 97161 | PT evaluation, low complexity | Per visit |
| 97162 | PT evaluation, moderate complexity | Per visit |
| 97163 | PT evaluation, high complexity | Per visit |
| 97110 | Therapeutic exercise | 15-min unit |
| 97112 | Neuromuscular re-education | 15-min unit |
| 97140 | Manual therapy | 15-min unit |
| 97530 | Therapeutic activities | 15-min unit |
Medicare pays 97161, 97162, and 97163 the same amount despite the complexity tiers, but commercial payers sometimes price them differently, so check all three lines on any fee schedule you're offered. Among the timed codes, the per-unit amounts differ enough that the mix you bill changes what an identical hour earns.
How does Medicare set the benchmark?
The Medicare Physician Fee Schedule assigns every CPT code a relative value, multiplies it by a conversion factor, and adjusts the result by a Geographic Practice Cost Index for your locality. Physical therapists are paid 100% of the resulting amount. Services furnished in whole or in part by a physical therapist assistant carry the CQ modifier and pay 85%.
Two more Medicare mechanics shape the real per-visit total. The multiple procedure payment reduction trims the practice-expense portion of every timed service after the first on the same day, so a three-unit visit pays less than three times a one-unit visit. And the annual therapy threshold requires the KX modifier once a patient's PT and SLP spending passes it.
The benchmark matters even if you never treat a Medicare patient, because commercial contracts are written against it. When a payer offers a per-unit rate for 97110, the useful comparison is the Medicare amount for your locality in the CMS Physician Fee Schedule lookup, not a national average.
What moves your commercial rate up or down?
Three things, in order of leverage: the contract, the locality, and the payer. Contract vintage dominates: most payers will not revisit a rate for at least a year after you countersign, so a schedule you accepted without negotiating follows you visit after visit. Fee schedules are available on request before signing, but payers do not volunteer them. A first remittance paying a default rate on 97110, discovered only after the contract is effective, is a number you then live with until the review window opens.
Locality is mechanical: the geographic adjustment moves the Medicare anchor, and the percentage in your contract rides on top of it. Payer matters least, in the sense that every national payer's network contains both strong and weak contracts. The question worth asking is where your offer sits inside that payer's local range, which is exactly what the reimbursement calculator shows.
What should you check before signing a PT fee schedule?
Request the fee schedule in writing before countersigning, then verify:
- Dollar amounts for 97161, 97162, and 97163. Confirm whether the three evaluation tiers pay the same or differently.
- Per-unit amounts for 97110, 97112, 97140, and 97530, stated as dollars, not "percent of our standard rate."
- Unit counting method. Medicare 8-minute rule or AMA per-code counting? Get it in writing; it changes your unit totals.
- Per-visit caps. Some contracts cap billable units or dollars per visit regardless of documented minutes.
- Assistant policy. Does the payer apply an 85% reduction for PTA-furnished services, and does it require the CQ modifier?
- The Medicare comparison. Look up each code for your locality in the CMS Physician Fee Schedule tool and note where the offer sits against it.
- Telehealth and re-evaluation (97164) rates, if you bill either.
- The rate review window: the earliest date you can request an increase, and the address the request goes to.
If you also bill occupational or speech services, the sibling guides cover the code mechanics for each: occupational therapy reimbursement rates and speech therapy reimbursement rates.
Seeing the numbers is step one; being in network is what lets you bill them. paneled.ai handles commercial credentialing for physical therapists for a flat $99 per payer, one time, and tracks each payer's fee schedule against the Medicare benchmark so you see the rate before you are locked into it.
Common questions
- How much does insurance pay for a physical therapy visit?
- There is no single number. A PT visit is billed as an untimed evaluation code or a stack of 15-minute timed units, and each payer prices each code separately by contract and locality. Commercial payers anchor those prices to the Medicare Physician Fee Schedule, so the same visit can pay very differently across payers in the same ZIP code.
- What is the 8-minute rule in physical therapy billing?
- Medicare's rule for counting 15-minute timed units. You bill one unit once you have furnished at least 8 minutes of a timed service: 8 to 22 minutes is one unit, 23 to 37 is two, 38 to 52 is three, and 53 to 67 is four. Many commercial payers follow it; some count each code separately under AMA rules instead, which can change your unit total.
- Do physical therapist assistants get paid less by Medicare?
- Yes. Services furnished in whole or in part by a PTA are billed with the CQ modifier and paid at 85% of the Physician Fee Schedule amount. Services a PT furnishes personally are paid at 100%. Some commercial payers copy the 85% tier into their own contracts, so check how each contract treats assistant-furnished care before you rely on PTA capacity.
- Why does the same CPT code pay differently in different states?
- Medicare applies a Geographic Practice Cost Index to every locality, so the fee schedule amount for a code like 97110 shifts by region. Commercial contracts are typically written as a percentage of Medicare, so the geographic adjustment flows into private rates too. Contract vintage and negotiation matter on top of that, which is why two clinics on the same street can hold different rates.
The paneled.ai team · Credentialing specialists. We file and track insurance credentialing applications for behavioral health providers every day — these guides come from what we see go wrong (and right) in real applications.