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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
$57.61 / $231.00 / $887.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.74 / $60.59 / $103.98
AmeriHealth
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.20 / $261.80 / $442.85
AmeriHealth
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.93 / $105.00 / $205.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$163.65 / $163.65 / $163.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.56 / $86.23 / $121.65
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $55.00 / $110.00
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.67 / $73.73 / $115.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.06 / $80.39 / $107.81