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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
$56.23 / $100.00 / $251.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $87.10 / $234.42
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $83.18 / $120.23
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $87.10 / $199.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.44 / $79.43 / $338.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $85.11 / $147.91
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $104.71 / $128.82
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $186.21 / $186.21
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $83.18 / $125.89
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $112.20 / $112.20
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.61 / $102.33 / $371.54
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $102.33 / $371.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.72 / $107.15 / $107.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $83.18 / $117.49