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New Jersey 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 $13–$400%20%10th90th$24Professionalmedian $16 · 10th–90th $13–$280%10%20%10th90th$16$10.0$20.0$50.0$100.0$200.0

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.88 / $23.99 / $39.81
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.88 / $15.14 / $20.89
AmeriHealth
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$14.13 / $14.13 / $14.13
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $28.18 / $50.12
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$20.42 / $30.90 / $40.74
Horizon BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$16.60 / $19.95 / $43.65
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$13.18 / $20.89 / $34.67