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Utah 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 $95 · 10th–90th $19–$1740%10%20%10th90th$95Professionalmedian $95 · 10th–90th $58–$3470%10%10th90th$95$20.0$50.0$100.0$200.0$500.0

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
$19.50 / $95.50 / $173.78
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $95.50 / $346.74
Aetna
Facility/Professional
Professional
Modifier
CQ
Typical Low / Median / Typical High
$85.11 / $144.54 / $144.54
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$72.44 / $72.44 / $75.86
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $87.10 / $177.83
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $177.83
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $141.25 / $181.97
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $104.71 / $123.03
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $102.33 / $114.82
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $131.83 / $190.55
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $112.20 / $112.20
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $87.10 / $114.82