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Texas 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
$63.10 / $154.88 / $457.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $83.18 / $218.78
Aetna
Facility/Professional
Professional
Modifier
CQ
Low / Median / High Price
$144.54 / $144.54 / $144.54
Ambetter
Facility/Professional
Professional
Modifier
CQ
Low / Median / High Price
$120.23 / $120.23 / $120.23
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.10 / $218.78 / $416.87
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $83.18 / $83.18
Baylor Scott & White
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.12 / $120.23 / $218.78
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $114.82 / $151.36
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.20 / $91.20 / $95.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $64.57 / $75.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $77.62 / $114.82
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $630.96 / $630.96
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $123.03 / $831.76
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.98 / $95.50 / $302.00
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $83.18 / $190.55
Moda Health
Facility/Professional
Professional
Modifier
CQ
Low / Median / High Price
$151.36 / $208.93 / $239.88
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $128.82
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.82 / $162.18 / $169.82
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $100.00 / $354.81
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $89.13 / $154.88
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $77.62 / $117.49
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.62 / $77.62 / $107.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $74.13 / $109.65
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $95.50 / $97.72