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Medicare reimbursement calculator for rehab therapy.

Medicare reimbursement calculator for rehab therapy.

Medicare reimbursement calculator for rehab therapy.

Pick your state and MAC locality, add your treatments, and see the expected Medicare payment — 8-minute-rule units, GP/GO and 59 modifiers, MPPR, and sequestration included.

Pick your state and MAC locality, add your treatments, and see the expected Medicare payment — 8-minute-rule units, GP/GO and 59 modifiers, MPPR, and sequestration included.

Discipline
Evaluation
Evaluation complexity

Treatments

Timed minutes pool into units under the CMS 8-minute rule
CodeDescriptionModsMinutesUnitsRateFeeMPPRTotal
97162Pt eval mod complex 30 minGPuntimed1$103.14$103.14full$103.14
97110Therapeutic exercisesGP1$30.53$30.53−$6.72$23.81
97140Manual therapy 1/> regionsGP1$29.12$29.12−$6.41$22.71
Fees shown for the selected locality

Payment summary

Total treatment time30 min
Billable units3
Fee schedule total$162.79
MPPR reduction−$13.12
Medicare allowed amount$149.67
Patient coinsurance (20%)$29.93
Medicare pays (80%)$119.73
Sequestration (−2%)−$2.39
Medicare payment$117.34
Total reimbursed$147.27

Estimates for planning only. Rates: 2026 MPFS non-facility. Units follow the CMS cumulative 8-minute rule with largest-remainder allocation. MPPR cuts the practice-expense portion of every unit after the highest-valued one by 50% (PE estimated at 44% of payment). Sequestration is withheld from Medicare's 80% share and is not billable to the patient. Modifier 59/X flags reflect active NCCI PTP edits (v32.2) — append only with documentation of a distinct service.

For reference only — always confirm payer-specific billing rules. Rates reflect the 2026 Medicare Physician Fee Schedule (non-facility).

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