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Connecticut 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
$104.71 / $257.04 / $416.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $81.28 / $165.96
Aetna
Facility/Professional
Professional
Modifier
CQ
Low / Median / High Price
$144.54 / $144.54 / $144.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$154.88 / $223.87 / $331.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $79.43 / $117.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $169.82 / $169.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $77.62 / $173.78
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.13 / $89.13 / $89.13
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $109.65 / $134.90
Health New England
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.53 / $269.15 / $389.05
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $75.86 / $158.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $89.13 / $123.03