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Nationwide rates for HCPCS 97161

Physical therapy evaluation: low complexity, requiring these components: A history with no personal factors and/or comorbidities that impact the plan of care; An examination of body system(s) using standardized tests and measures addressing 1-2 elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions; A clinical presentation with stable and/or uncomplicated characteristics; and Clinical decision making of low complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 20 minutes are spent face-to-face with the patient and/or family.

Facilitymedian $141 · 10th–90th $72–$3550%10%10th90th$141Professionalmedian $91 · 10th–90th $58–$2510%10%20%10th90th$91$0.2$2.0$20.0$200.0$2.0K$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
$70.79 / $158.49 / $354.81
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $89.13 / $251.19
Aetna
Facility/Professional
Professional
Modifier
CQ
Typical Low / Median / Typical High
$19.05 / $144.54 / $208.93
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $95.50 / $239.88
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $77.62 / $147.91
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$57.54 / $79.43 / $316.23
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $85.11 / $162.18
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $107.15 / $128.82
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $79.43 / $158.49

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