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Washington 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 $26 · 10th–90th $19–$490%10%20%10th90th$26Professionalmedian $21 · 10th–90th $13–$380%10%20%10th90th$21$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
$20.42 / $43.65 / $117.49
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.88 / $16.98 / $38.02
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.18 / $28.18 / $28.18
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$19.05 / $21.88 / $40.74
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.85 / $22.91 / $58.88
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$19.50 / $24.55 / $42.66
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$18.62 / $24.55 / $35.48
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.30 / $32.36 / $33.11
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$27.54 / $42.66 / $43.65
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$29.51 / $29.51 / $29.51
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$21.38 / $21.38 / $52.48
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$19.05 / $21.88 / $38.02
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$14.79 / $18.20 / $20.42
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$20.89 / $23.44 / $53.70
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$21.38 / $22.91 / $43.65