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Delaware 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 $63–$6610%20%10th90th$115Professionalmedian $79 · 10th–90th $48–$2140%10%10th90th$79$50.0$100.0$200.0$500.0

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
$63.10 / $114.82 / $660.69
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $79.43 / $213.80
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $64.57 / $64.57
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $83.18 / $117.49
Highmark BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$263.03 / $263.03 / $263.03
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $87.10 / $194.98