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New York 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 $30 · 10th–90th $16–$3310%20%10th90th$30Professionalmedian $18 · 10th–90th $13–$450%20%10th90th$18$10.0$50.0$200.0$1.0K$5.0K$20.0K

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
$15.85 / $30.20 / $331.13
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.88 / $15.14 / $30.90
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$16.98 / $21.38 / $36.31
CDPHP
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$31.62 / $31.62 / $31.62
CDPHP
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$31.62 / $31.62 / $31.62
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$35.48 / $35.48 / $100.00
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$13.80 / $28.84 / $74.13
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$20.89 / $20.89 / $85.11
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$20.42 / $28.18 / $44.67
Excellus BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$20.42 / $20.42 / $20.42
Excellus BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $27.54 / $45.71
MVP Health Care
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$24.55 / $32.36 / $77.62
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$18.20 / $20.42 / $23.44
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$18.20 / $34.67 / $85.11
Univera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$17.38 / $23.44 / $23.44
Univera
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $23.99 / $45.71