go back

Michigan 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 $120 · 10th–90th $76–$2140%20%10th90th$120Professionalmedian $83 · 10th–90th $58–$2140%10%10th90th$83$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
$75.86 / $120.23 / $213.80
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $83.18 / $229.09
Aetna
Facility/Professional
Professional
Modifier
CQ
Typical Low / Median / Typical High
$89.13 / $89.13 / $89.13
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $83.18 / $83.18
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$93.33 / $134.90 / $169.82
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $87.10 / $87.10
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $77.62 / $117.49
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $97.72 / $112.20
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$53.70 / $53.70 / $64.57
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $85.11 / $229.09
Health Alliance Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$75.86 / $79.43 / $213.80
Health Alliance Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $83.18 / $177.83
Priority Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $70.79 / $117.49
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $97.72 / $97.72
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $79.43 / $112.20