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Georgia 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 $148 · 10th–90th $66–$3390%10%10th90th$148Professionalmedian $87 · 10th–90th $58–$1860%10%10th90th$87$1.0$5.0$20.0$100.0$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
$66.07 / $147.91 / $338.84
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $91.20 / $199.53
Aetna
Facility/Professional
Professional
Modifier
CQ
Typical Low / Median / Typical High
$19.05 / $19.05 / $19.05
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $162.18 / $162.18
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $85.11 / $141.25
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$93.33 / $134.90 / $162.18
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $109.65 / $218.78
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$60.26 / $70.79 / $97.72
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $81.28 / $154.88
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $97.72 / $144.54
Oscar Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$151.36 / $251.19 / $407.38
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $131.83 / $141.25
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $97.72 / $144.54
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $83.18 / $138.04