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North Carolina 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
$83.84 / $138.56 / $235.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.74 / $83.84 / $205.14
Aetna
Facility/Professional
Professional
Modifier
CQ
Low / Median / High Price
$94.11 / $94.11 / $94.11
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.74 / $111.28 / $174.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.88 / $75.29 / $139.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.00 / $186.00 / $186.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.26 / $80.01 / $141.05
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$73.73 / $94.93 / $123.24
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.16 / $94.93 / $94.93
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$265.29 / $269.64 / $544.98
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.19 / $154.75 / $180.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.23 / $81.68 / $127.66
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$184.07 / $225.88 / $516.79
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$633.66 / $824.10 / $824.10