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Wisconsin 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 $214 · 10th–90th $79–$3630%10%10th90th$214Professionalmedian $107 · 10th–90th $63–$3020%10%10th90th$107$10.0$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
$91.20 / $281.84 / $380.19
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $97.72 / $288.40
Aetna
Facility/Professional
Professional
Modifier
CQ
Typical Low / Median / Typical High
$131.83 / $131.83 / $131.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $81.28 / $263.03
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$93.33 / $93.33 / $125.89
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $93.33 / $97.72
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $269.15 / $363.08
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $141.25 / $302.00
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$67.61 / $95.50 / $204.17
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $190.55 / $288.40
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$83.18 / $213.80 / $316.23
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $128.82 / $323.59
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $64.57
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$151.36 / $151.36 / $151.36
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $114.82 / $239.88
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $213.80 / $316.23
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $125.89 / $630.96
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $426.58 / $630.96
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Security Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$154.88 / $154.88 / $154.88
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $204.17 / $281.84
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$107.15 / $107.15 / $107.15
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $100.00 / $316.23