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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.

Facilitymedian $148 · 10th–90th $63–$4370%5%10th90th$148Professionalmedian $83 · 10th–90th $58–$1740%20%10th90th$83$50.0$200.0$1.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $154.88 / $457.09
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $77.62 / $208.93
Aetna
Facility/Professional
Professional
Modifier
CQ
Typical Low / Median / Typical High
$144.54 / $144.54 / $144.54
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$87.10 / $218.78 / $416.87
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $83.18 / $83.18
Baylor Scott & White
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$50.12 / $120.23 / $218.78
Baylor Scott & White
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $109.65 / $151.36
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$91.20 / $91.20 / $95.50
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $64.57 / $75.86
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $77.62 / $117.49
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$147.91 / $630.96 / $630.96
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $158.49 / $831.76
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $95.50 / $218.78
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $81.28 / $181.97
Moda Health
Facility/Professional
Professional
Modifier
CQ
Typical Low / Median / Typical High
$144.54 / $144.54 / $144.54
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $128.82
Oscar Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$123.03 / $162.18 / $169.82
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $97.72 / $363.08
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $91.20 / $151.36
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $77.62 / $117.49
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $77.62 / $144.54
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $74.13 / $112.20
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $97.72 / $97.72