go back

Maine rates for HCPCS 97130

Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; each additional 15 minutes (List separately in addition to code for primary procedure)

Facilitymedian $24 · 10th–90th $24–$240%50%100%$24Professionalmedian $18 · 10th–90th $13–$380%10%10th90th$18$10.0$20.0$50.0$100.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$23.99 / $23.99 / $23.99
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.88 / $15.85 / $20.89
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$14.45 / $20.89 / $30.90
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$17.78 / $26.30 / $50.12
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$17.38 / $23.99 / $47.86
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.88 / $15.85 / $20.89
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$19.50 / $28.18 / $61.66