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Virginia 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
$55.74 / $100.94 / $234.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.74 / $69.52 / $133.16
Aetna
Facility/Professional
Professional
Modifier
CQ
Low / Median / High Price
$94.11 / $94.11 / $94.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.56 / $78.95 / $108.19
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.08 / $78.73 / $165.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.00 / $75.00 / $202.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.97 / $84.35 / $126.31
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.06 / $104.57 / $128.78
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.74 / $85.45 / $121.23
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $112.00 / $176.65
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.41 / $97.49 / $183.86
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.41 / $97.49 / $183.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.45 / $86.62 / $118.05