97116

Therapy procedure for walking training, each 15 minutes

Medicare pricing data for 48,180 providers across 52 states

🤖AI Overview

This is one of the most commonly performed procedures in Medicare, with 4.6 million services annually. Even small pricing inefficiencies here affect millions of patients. Note: These costs reflect the Medicare physician/supplier component. Hospital facility fees are billed separately and can be 2-5x the physician fee.

💡 What You Should Know

Therapy procedure for walking training, each 15 minutes (HCPCS code 97116) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $22.48, but hospitals typically charge $55.96 — a 2.5x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$4.50

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $22.48, your out-of-pocket cost would be approximately $4.50. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$22.48
Average Hospital Charge
$55.96
Markup Ratio
2.5x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$55.96
Medicare Allowed$22.48
Medicare Payment$17.57

Hospitals charge 2.5x more than what Medicare allows for this procedure. Medicare actually pays $17.57 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Alaska$29$781875,280+29.7%
District of Columbia$25$591149,050+9.3%
New York$25$614,499737,145+9.0%
New Jersey$24$632,917505,547+6.0%
California$23$494,146336,809+4.2%
Maryland$23$541,474147,289+4.0%
Massachusetts$23$541,20198,106+3.7%
Connecticut$23$5460355,871+3.6%
Hawaii$23$4921811,429+1.2%
Washington$23$501,27451,822+0.8%
Virginia$23$551,334113,189+0.8%
Rhode Island$23$5829811,492+0.5%
Delaware$22$6034440,553-0.4%
Pennsylvania$22$542,124242,187-0.6%
New Hampshire$22$5427016,990-1.4%
Oregon$22$5654319,088-1.6%
Colorado$22$521,13859,035-1.8%
North Dakota$22$831868,190-2.0%
Minnesota$22$701,05226,042-2.1%
Michigan$22$621,40473,176-2.5%
Maine$22$5628316,892-2.7%
Montana$22$5030511,364-2.9%
Nevada$22$5140737,390-3.2%
Utah$22$4833729,465-3.5%
Vermont$22$511293,915-3.6%
South Dakota$22$5622115,362-3.9%
Wyoming$22$5625417,081-3.9%
Arizona$22$531,18578,932-4.2%
Texas$22$572,120142,959-4.4%
Illinois$21$541,778214,914-4.6%
Puerto Rico$21$30621,610-4.8%
Idaho$21$4530716,107-4.8%
Georgia$21$541,277122,687-5.0%
Florida$21$532,677416,605-5.2%
Wisconsin$21$6293947,368-5.5%
South Carolina$21$53860101,111-5.9%
North Carolina$21$491,38088,214-6.6%
Indiana$21$6090989,543-6.7%
Louisiana$21$5364740,439-6.9%
Ohio$21$551,04297,008-6.9%
Iowa$21$5349529,996-7.1%
Nebraska$21$5536521,843-7.3%
Kansas$21$5141236,045-7.6%
Tennessee$21$5081879,685-7.7%
New Mexico$21$4522311,900-8.1%
Oklahoma$21$5839623,199-8.1%
Missouri$21$5951576,444-8.2%
Alabama$21$5084741,079-8.5%
Arkansas$20$5041530,227-8.9%
Mississippi$20$4836935,197-9.0%
Kentucky$20$5460051,513-9.5%
West Virginia$20$4421912,154-11.4%

⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.

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