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California 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.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.28 / $257.04 / $489.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $91.20 / $346.74
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $87.10 / $97.72
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.62 / $95.50 / $239.88
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $104.71 / $245.47
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.72 / $194.98 / $257.04
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $75.86 / $190.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.44 / $85.11 / $316.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $87.10 / $151.36
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $104.71 / $162.18
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $109.65 / $190.55
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.90 / $630.96 / $630.96
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $134.90 / $831.76
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $141.25 / $724.44
Optum
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.90 / $30.90 / $39.81
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.26 / $107.15 / $162.18
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $87.10 / $186.21
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $281.84 / $281.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.72 / $97.72 / $97.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $87.10 / $181.97