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Washington, DC rates for HCPCS 97162

Physical therapy evaluation: moderate complexity, requiring these components: A history of present problem with 1-2 personal factors and/or comorbidities that impact the plan of care; An examination of body systems using standardized tests and measures in addressing a total of 3 or more elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions; An evolving clinical presentation with changing characteristics; and Clinical decision making of moderate complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 30 minutes are spent face-to-face with the patient and/or family.

Facilitymedian $191 · 10th–90th $78–$2630%20%10th90th$191Professionalmedian $91 · 10th–90th $55–$2040%10%10th90th$91$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
$77.62 / $190.55 / $263.03
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $89.13 / $204.17
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$120.23 / $120.23 / $120.23
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $147.91 / $501.19
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $77.62 / $234.42
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $109.65 / $169.82
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$69.18 / $107.15 / $107.15
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $97.72 / $229.09