Free tool · CMS 2026 fee schedule, October release
2026 Medicare therapy rate calculator
See what Medicare actually allows for a visit in your area: every code and unit, with the multiple procedure reduction and the CQ/CO assistant rate applied, straight from CMS’s 2026 files.
2026 Medicare payment for a visit
Of the $100.70 allowed, Medicare pays 80% ($80.56) and the patient or their supplemental plan 20% ($20.14), once the Part B deductible is met.
What one missed unit a visit costs over a year
If one in four visits is billed one unit of 97110 short (for example, by miscounting minutes under the 8-minute rule), that is about $16,659 a year in allowed amounts at 3,000 visits (50 working weeks), counting the unit at its reduced rate. Check every visit with the 8-minute rule calculator.
Amounts are the 2026 Medicare physician fee schedule allowed amounts, from CMS’s October 2026 relative value file (RVU26D) and 2026 GPCIs, at the standard conversion factor of $33.4009. They include the 50% therapy practice-expense reduction for second and later units and the 85% rate for CQ/CO services. Private practices are paid the non-facility rate; use the facility rate only if your Medicare contractor pays you that way. They don’t include sequestration, deductibles or your contractor’s rounding, so a remittance can differ by a few cents.
How Medicare works out a therapy payment
Every code on the physician fee schedule has three relative values: work, practice expense (PE) and malpractice (MP). Each is multiplied by your locality’s geographic index (GPCI), added up, and multiplied by the conversion factor, $33.4009 for 2026 (Hall Render summary of the final rule; CMS relative value files). Then two therapy rules apply:
- Multiple procedure payment reduction. On a day with more than one unit of “always therapy” services, the unit with the highest PE value is paid in full and the PE part of every other unit is paid at 50%, across all disciplines that day (CMS; First Coast).
- Assistant differential. Services furnished in whole or in part by a PTA or OTA (CQ or CO modifier) are paid at 85% (CMS).
Example: a typical 53-minute visit, national rates
Two units of therapeutic exercise (97110), one of manual therapy (97140) and one of therapeutic activities (97530). Before reductions the four units come to about $120.91. 97530 has the highest practice-expense value (0.6 RVU), so it is paid in full; the other three units lose half their practice-expense part. The calculator above starts with this visit; change the state to see your own figure.
2026 national rates for common therapy codes
| Code | Service | Private practice | Facility rate |
|---|---|---|---|
| 97110 | Therapeutic exercise | $29.06 | $29.06 |
| 97112 | Neuromuscular re-education | $32.73 | $32.73 |
| 97116 | Gait training | $29.06 | $29.06 |
| 97140 | Manual therapy | $27.72 | $27.72 |
| 97530 | Therapeutic activities | $35.07 | $35.07 |
| 97535 | Self-care and home management training | $32.40 | $32.40 |
| 97161 | PT evaluation, low complexity | $97.86 | $97.86 |
| 97162 | PT evaluation, moderate complexity | $97.86 | $97.86 |
| 97163 | PT evaluation, high complexity | $97.86 | $97.86 |
| 97164 | PT re-evaluation | $67.47 | $67.47 |
| 97165 | OT evaluation, low complexity | $100.54 | $100.54 |
| 97166 | OT evaluation, moderate complexity | $100.54 | $100.54 |
| 97167 | OT evaluation, high complexity | $100.54 | $100.54 |
| 97168 | OT re-evaluation | $68.47 | $68.47 |
| 92507 | Speech, language or voice treatment, individual | $76.15 | $76.15 |
| 92526 | Treatment of swallowing dysfunction | $84.17 | $84.17 |
One unit, no geographic adjustment, before the multiple procedure reduction. Source: CMS RVU26D relative value file, conversion factor $33.4009. Check any code on CMS’s look-up tool.
For a full explanation with worked examples, see the 2026 Medicare therapy fee schedule guide.
Questions
How much does Medicare pay for 97110 in 2026?
About $29.06 per unit nationally in private practice before any reduction, adjusted up or down for your locality. Second and later therapy units on the same day are paid less because of the multiple procedure payment reduction.
What is the multiple procedure payment reduction (MPPR) for therapy?
When a patient gets more than one unit of “always therapy” services on the same day, Medicare pays the unit with the highest practice-expense value in full and cuts the practice-expense part of every other unit by 50%. It has been 50% since April 1, 2013.
How much less is paid for services by a PTA or OTA?
Services furnished in whole or in part by a physical or occupational therapy assistant, marked with the CQ or CO modifier, are paid at 85% of the normal amount, since January 1, 2022. Assistant time of 10% or less of a service does not trigger the modifier.
What conversion factor does this use?
$33.4009, the 2026 conversion factor for clinicians who are not qualifying APM participants, which covers almost all therapy private practices. Qualifying APM participants use $33.5675.
Why might my payment be a little different?
Medicare also applies sequestration to its share, the patient’s deductible and coinsurance change who pays, and contractors round each step. Use the calculator for planning and CMS’s own look-up tool or your remittance for the exact figure.
Do these rates apply to Medicare Advantage or commercial plans?
No. They are traditional Medicare Part B rates. Medicare Advantage and commercial plans pay under their own contracts, though many are set as a percentage of Medicare.
Sources
- CMS, PFS Relative Value Files: RVU26D (released August 26, 2026)
- CMS, CY 2026 Therapy Services Updates (MPPR, CQ/CO, KX threshold)
- First Coast Service Options (Medicare contractor), Multiple procedure payment reduction
- Hall Render, Key highlights from the 2026 Medicare Physician Fee Schedule final rule (conversion factors)
- CMS, Physician Fee Schedule look-up tool
This tool gives information, not billing advice. Payment depends on coverage, documentation and your contractor’s processing.