Therapeutic Exercise (Physical Therapy, per 15 Minutes)
CPT 97110 is the most commonly billed physical therapy code in America, with 64.8 million services billed to Medicare alone. It covers therapeutic exercise (stretching, strengthening, range of motion) and is billed per 15-minute unit. Providers charge an average of $67.22 per unit, but Medicare pays only $29.06 (2.3x markup). A typical PT session includes 3 to 5 units of various codes, making the total session $100 to $250 through insurance.
CPT 97110 at a Glance
- Average provider charge: $67.22 per unit
- Medicare rate: $29.06 per unit
- Typical markup: 2.3x over Medicare rate
- Cash-pay PT session: $75 to $150
- Unit: Per 15 minutes
- Hospital-based PT session: $250 to $500
- Beneficiaries (2023): 3.0 million
- Total services (2023): 64.8 million
On this page
How the Medicare Rate Is Calculated
Medicare values every procedure using Relative Value Units (RVUs) across three components, then multiplies by a national conversion factor of $33.4009 (2026). For CPT 97110, the non-facility and facility Practice Expense RVUs are the same, so Medicare pays the same physician fee regardless of setting. However, hospital-based PT practices add a facility fee on top.
| Component | What It Covers | RVU (per unit) |
|---|---|---|
| Work RVU | Therapist time, skill, and clinical judgment | 0.45 |
| Practice Expense RVU | Facility, equipment, staff support | 0.41 |
| Malpractice RVU | Professional liability insurance | 0.01 |
| Total RVU | 0.87 | |
| x $33.4009 | 2026 conversion factor | $29.06 |
Medicare Rate by State
Medicare adjusts the national rate based on your location using Geographic Practice Cost Indices (GPCIs). The per-unit rate ranges from about $27 in Arkansas to $37 in Alaska.
Medicare Rate by State (2026)
Medicare adjusts payments by location using Geographic Practice Cost Indices (GPCIs). Select your state to see the adjusted rate.
Sample State Rates (per 15-minute unit)
| State | Medicare Pays | Avg. Charge | Markup |
|---|---|---|---|
| Texas (Austin) | $29.84 | $67.22 | 2.3x |
| California (Los Angeles) | $32.07 | $67.22 | 2.1x |
| New York (Manhattan) | $32.43 | $67.22 | 2.1x |
| Florida (Fort Lauderdale) | $29.51 | $67.22 | 2.3x |
| Ohio | $27.87 | $67.22 | 2.4x |
| Mississippi | $27.07 | $67.22 | 2.5x |
| Arkansas | $26.97 | $67.22 | 2.5x |
| Alaska | $37.31 | $67.22 | 1.8x |
Rates shown are per 15-minute unit using 2026 GPCIs and the $33.4009 conversion factor. The average provider charge of $67.22 is the 2023 national average from CMS utilization data. Actual charges vary by provider.
The 8-Minute Rule: How PT Units Are Counted
Medicare uses the 8-minute rule to determine how many units can be billed for timed PT codes like 97110. A therapist must provide at least 8 minutes of a service to bill one unit. Here is how total treatment minutes translate to billable units across all timed codes:
| Total Timed Minutes | Maximum Billable Units |
|---|---|
| 8 to 22 minutes | 1 unit |
| 23 to 37 minutes | 2 units |
| 38 to 52 minutes | 3 units |
| 53 to 67 minutes | 4 units |
| 68 to 82 minutes | 5 units |
What Insured Patients Actually Pay for Physical Therapy
PT costs add up because patients typically attend 2 to 3 sessions per week over several weeks. Your per-session cost depends on your plan design, and costs below are for a typical 3 to 4 unit session (one hour).
| Your Situation | What You Likely Pay (per session) | How It Works |
|---|---|---|
| Copay plan (deductible met) | $25 to $75 | Flat copay per PT visit, regardless of units billed |
| Coinsurance plan (deductible met) | $20 to $50 | 20% of negotiated rate per session ($100 to $250) |
| High-deductible plan (deductible NOT met) | $100 to $250 | Full negotiated rate until deductible is met |
| Medicare Part B | $17 to $29 | 20% of Medicare-approved amount for 3-4 units |
Should You Use Insurance or Pay Cash for PT?
Cash-pay PT clinics charge $75 to $150 per session. Hospital-based PT can be $250 to $500 per session. If you have a high-deductible plan and have not met your deductible, cash-pay may save you significantly, especially over a multi-week course of treatment.
When Cash-Pay Wins
- Your per-session insurance rate is higher than $100 to $150
- You have a high deductible and are unlikely to meet it
- You can find a cash-pay or direct-access PT clinic
- You want predictable pricing per visit
When Using Insurance Wins
- Your copay is less than $50 per visit
- You are close to meeting your deductible
- You need many sessions (approaching your out-of-pocket max)
- Your plan covers PT at a good coinsurance rate
Common Billing Problems with Physical Therapy
Overbilling units (violating the 8-minute rule)
Some practices bill 4 units of 97110 for a session where only 45 minutes of total treatment occurred across all codes. Under the 8-minute rule, 45 minutes of timed treatment only justifies 3 units total (across all timed codes). Review your bill and compare total units billed to your actual treatment time. If the numbers do not add up, contact the billing department.
Code substitution: billing 97110 when a different code was performed
CPT 97110 (therapeutic exercise) pays differently than 97530 (therapeutic activities) or 97140 (manual therapy). Some practices default to billing 97110 for all services, even when manual therapy or functional activities were actually provided. If your therapist spent most of the session doing hands-on manual therapy, the bill should reflect 97140, not 97110.
Hospital-based PT facility fees
If your physical therapist works in a hospital-owned clinic, the hospital adds a facility fee on top of the therapist's professional charge. This can double the cost of each session. Many patients do not realize their PT office was acquired by a hospital system until they see the facility fee on their bill. Ask about this before starting treatment.
Stacking too many codes per session
A PT session may include 97110 (exercise) + 97140 (manual therapy) + 97530 (activities) + 97035 (ultrasound) + 97112 (neuromuscular re-education). Each is billed per unit. Review your bill to ensure the total time across all codes matches your session length. A one-hour session should not show 5 to 6 units of timed services (that would require 75 to 90 minutes of treatment time).
Related Physical Therapy Codes
| Code | Description | Billing |
|---|---|---|
| 97110 | Therapeutic exercise | Per 15 min (this page) |
| 97112 | Neuromuscular re-education | Per 15 min |
| 97140 | Manual therapy (hands-on techniques) | Per 15 min |
| 97530 | Therapeutic activities (functional tasks) | Per 15 min |
| 97035 | Ultrasound therapy | Per 15 min |
Frequently Asked Questions
How much does physical therapy cost per session?
A typical PT session costs $100 to $250 through insurance (before your plan adjustments) because it includes 3 to 5 different CPT codes, each billed per 15-minute unit. Cash-pay PT clinics charge $75 to $150 per session. Hospital-based PT can be $250 to $500 per session due to facility fees. The most common code, 97110 (therapeutic exercise), has a Medicare rate of $29.06 per unit.
What is the 8-minute rule in physical therapy billing?
The 8-minute rule determines how many units a therapist can bill. A therapist must provide at least 8 minutes of a service to bill one unit. For 2 units, at least 23 minutes are required (across all timed codes combined). If your bill shows 4 units total but your entire session was only 45 minutes, the billing may be incorrect because 4 units require at least 53 minutes.
Does Medicare limit how much physical therapy I can get?
Medicare does not have a hard cap on physical therapy, but there is a threshold of $2,330 (2026) above which services require medical review to continue. This is not a spending limit; it is a review trigger. Your therapist must document medical necessity for continued treatment above this threshold. Many commercial insurance plans cap PT at 20 to 30 visits per year.
Why does my PT bill have so many different codes?
PT sessions typically include multiple types of treatment, each with its own CPT code: 97110 (therapeutic exercise), 97140 (manual therapy), 97530 (therapeutic activities), 97112 (neuromuscular re-education), and 97035 (ultrasound). Each code is billed per 15-minute unit. A one-hour session may show 4 to 5 different codes totaling 4 units. Review your bill to ensure total billed units match total treatment time using the 8-minute rule.
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