How much will Medicare actually pay for the visit you just finished? Between the 8-minute rule, modifiers, MPPR, and sequestration, the honest answer is usually less than the fee schedule says. Our free PT Medicare reimbursement calculator runs the whole chain of math for you — pick your locality, add your treatments, and see the real number in seconds.

What’s inside the calculator

8-minute rule unit calculator

Timed codes don’t earn a unit per line — Medicare pools every timed minute in the visit, converts the total to units, and allocates them by largest remainder. The calculator applies the CMS cumulative method automatically, so 20 minutes of therapeutic exercise plus 20 minutes of therapeutic activities correctly yields three units, not two. Untimed codes like evaluations, group therapy, and unattended modalities are billed as one unit regardless of time. If you only need units, our 8-Minute Rule Calculator does that piece on its own.

GP, GO, and 59 modifiers, flagged inline

Every line gets its therapy modifier automatically — GP under a physical therapy plan of care, GO under occupational therapy. The 59 modifier only appears when an active NCCI procedure-to-procedure edit pair is actually on your claim, like group therapy billed alongside therapeutic exercise. Retired pairs that many billers still flag out of habit — 97140 with 97530, for example — correctly show nothing, because that edit was deleted in 2020.

2026 Medicare fee schedule, priced to your locality

The same CPT code pays differently in San Francisco than it does in rural Kansas. The calculator carries the 2026 Medicare Physician Fee Schedule non-facility rates for all 109 MAC localities, so the dollars you see match the jurisdiction you actually bill under.

MPPR and sequestration, applied in the right order

The multiple procedure payment reduction cuts the practice-expense portion of every unit after your highest-valued one by 50% — roughly a 20% haircut on each additional unit. Sequestration then withholds 2% of Medicare’s share after coinsurance is carved out. The calculator applies both in the correct sequence, which is where most back-of-the-napkin estimates go wrong.

Patient coinsurance

Once the deductible is met, the patient owes 20% of the Medicare allowed amount — after MPPR, but before sequestration. The calculator breaks this out so your front desk knows exactly what to collect at the visit, and so you never mistakenly balance-bill the sequestration amount, which is not patient responsibility.

Total reimbursement

The bottom line: patient coinsurance plus Medicare’s payment after sequestration — the amount that actually lands in your bank account for the visit, with per-line totals so you can see which services carry the payment.

How to use it

1. Select your state and MAC locality. The fee schedule loads for your jurisdiction — every rate on the page updates instantly.

2. Choose your discipline. Physical therapy or occupational therapy — this sets the GP or GO modifier and swaps the evaluation code family.

3. Add an evaluation if you performed one. Toggle it on and pick the complexity — low, moderate, or high (97161–97163 for PT, 97165–97167 for OT). Evals are untimed, so they bill one unit at any length.

4. Add your treatments. Pick CPT codes from the dropdown — therapeutic exercise, manual therapy, modalities, and everything else on the therapy fee schedule.

5. Enter your minutes. Timed codes get a quick stepper; type or tap to adjust. Units recalculate under the 8-minute rule as you go.

6. Review the payment summary. Fee schedule total, MPPR reduction, Medicare allowed amount, patient coinsurance, sequestration, and the total reimbursed — the full waterfall in one card.

Try it on your next visit

Run a typical visit through the calculator and compare it to what your payer actually remitted — the gap is usually MPPR and sequestration doing quiet work. The figures are planning estimates, so always confirm payer-specific rules. And if you’d rather never do this math by hand at all, PatientStudio checks units and modifiers automatically on every note.