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New York 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
$42.27 / $140.58 / $363.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.10 / $73.00 / $252.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$654.00 / $664.00 / $919.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.11 / $75.00 / $159.01
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.08 / $90.08 / $133.00
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.08 / $90.08 / $90.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $125.00 / $350.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.34 / $86.23 / $125.53
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.00 / $145.35 / $332.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $55.00 / $123.00
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.27 / $118.05 / $119.09
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.00 / $94.35 / $150.13
Fidelis
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.00 / $80.00 / $89.45
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.89 / $207.09 / $224.62
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.22 / $87.17 / $156.25
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$113.06 / $555.00 / $597.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.14 / $97.88 / $205.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.14 / $87.70 / $153.51
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.27 / $111.00 / $119.47
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.80 / $98.16 / $214.79