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New Jersey 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
$75.86 / $199.53 / $354.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $87.10 / $309.03
AmeriHealth
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.04 / $295.12 / $588.84
AmeriHealth
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $104.71 / $204.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.18 / $162.18 / $162.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $75.86 / $131.83
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $114.82 / $134.90
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $77.62 / $194.98
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.10 / $97.72 / $107.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $81.28 / $107.15