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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.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.64 / $197.49 / $381.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.45 / $91.50 / $325.00
Aetna
Facility/Professional
Professional
Modifier
CQ
Low / Median / High Price
$130.99 / $130.99 / $271.63
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.49 / $81.61 / $272.68
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.88 / $163.52 / $163.52
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.69 / $93.88 / $121.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $301.91 / $361.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.50 / $107.08 / $293.89
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.69 / $95.13 / $199.10
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68.09 / $199.10 / $308.27
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.70 / $96.95 / $315.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.78 / $95.09 / $203.25
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.74 / $95.13 / $199.10
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.81 / $233.70 / $327.79
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $85.00 / $458.69
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.98 / $437.67 / $633.66
Security Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$156.66 / $156.66 / $156.66
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.84 / $282.57 / $282.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.70 / $87.70 / $199.23