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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.

Facilitymedian $115 · 10th–90th $78–$4370%10%10th90th$115Professionalmedian $95 · 10th–90th $58–$3310%10%10th90th$95$20.0$100.0$500.0$2.0K$10.0K

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
$83.18 / $245.47 / $478.63
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $93.33 / $331.13
Aetna
Facility/Professional
Professional
Modifier
CQ
Typical Low / Median / Typical High
$144.54 / $144.54 / $144.54
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $87.10 / $97.72
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $95.50 / $239.88
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $104.71 / $245.47
Blue Shield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $181.97 / $269.15
Blue Shield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $75.86 / $186.21
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$60.26 / $85.11 / $316.23
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $87.10 / $173.78
Contra Costa Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $104.71 / $162.18
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $107.15 / $190.55
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $630.96 / $630.96
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $134.90 / $831.76
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $141.25 / $724.44
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.90 / $39.81 / $70.79
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$61.66 / $107.15 / $162.18
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $87.10 / $186.21
Sutter Health Plus
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$281.84 / $281.84 / $281.84
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $97.72 / $302.00
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $87.10 / $194.98