Barber began his Piano Concerto in March 1960. John Browning was the intended soloist from the outset, the work being written with his keyboard technique in mind. The second movement had begun life as an Elegy for flute and piano in the summer of 1959, the composer slightly extending it in the process of orchestration. Although the first two movements were completed before the end of 1960, the death of Barber's sister in July 1961 and an invitation to attend the Congress of Soviet Composers in March the following year impeded further work. Not until 9 September 1962 was the final movement completed, just in time for the première, in which Browning was joined by Erich Leinsdorf and the Boston Symphony, on 24 September. Awarded the Pulitzer Prize in 1963 and the Music Critics' Circle Award in 1964, the Piano Concerto marks the zenith of Barber's public acclaim.

The soloist opens the work with an imperious cadenza passage, brusque orchestral chords presaging the agitated first theme. This is developed in capricious dialogue between piano and woodwind, before flute and horn round off the section with a brief codetta. The oboe now introduces the plaintive second theme, given more expressive treatment by strings before an anticipatory interlude reintroduces the soloist. Its rippling ostinato motion sees aspects of the first theme discussed, before a brief recall of the second theme, and a purposeful drive to the movement's climax, from where the soloist leads off with a virtuosic cadenza. At its apex, the orchestra re-enters stormily with the first theme, and a modified reprise takes place, the second theme dreamily expressive on piano then strings. This moves directly into a brief but vivid coda, the first theme defiant on full orchestra. The Canzone opens with a gently undulating motion on strings, over which solo woodwind spin a wistful melodic idea. This is taken up by the soloist, and a bitter-sweet dialogue ensues. Strings mark the movement's mid-point with a hushed interlude, before the soloist develops the theme into an intricate arabesque. The orchestra muses further, and the movement ends in gentle resignation. This is in contrast with the Finale, which bursts in with an angry brass gesture, the soloist heading off with an energetic idea spanning the full range of the keyboard. Over a skeletal xylophone, the dryly ironic second theme is heard, before the initial motion drives to a brief climax. The second theme now resumes as a perky dialogue for woodwind over pizzicato strings, the soloist adding a subtle commentary which draws in the whole orchestra. The first theme is distantly recalled by solo wind, tension increasing remorselessly as the soloist spurs the orchestra on in a final dash to the finish.