go back

Massachusetts 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 $209 · 10th–90th $65–$4370%10%10th90th$209Professionalmedian $98 · 10th–90th $55–$2400%10%10th90th$98$50.0$200.0$1.0K$5.0K$20.0K

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
$81.28 / $251.19 / $467.74
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $85.11 / $223.87
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$120.23 / $120.23 / $120.23
Aetna
Facility/Professional
Professional
Modifier
CQ
Typical Low / Median / Typical High
$85.11 / $85.11 / $85.11
AllWays Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $186.21 / $630.96
AllWays Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $114.82 / $281.84
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$165.96 / $213.80 / $275.42
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $120.23 / $120.23
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$89.13 / $89.13 / $295.12
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $85.11 / $229.09
Fallon Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$46.77 / $89.13 / $194.98
Fallon Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$46.77 / $85.11 / $162.18
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $117.49 / $257.04
Health New England
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $141.25 / $309.03
Health New England
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $58.88 / $154.88
Mass General Brigham
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $186.21 / $630.96
Mass General Brigham
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $114.82 / $281.84
Tufts
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $75.86 / $398.11
Tufts
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $64.57 / $128.82
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$69.18 / $97.72 / $97.72
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $100.00 / $269.15