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Maryland 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 $339 · 10th–90th $87–$9120%10%10th90th$339Professionalmedian $81 · 10th–90th $58–$2140%10%20%10th90th$81$50.0$200.0$1.0K$5.0K$20.0K$100.0K

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
$87.10 / $338.84 / $912.01
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $81.28 / $229.09
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
$57.54 / $57.54 / $57.54
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $83.18 / $89.13
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$72.44 / $72.44 / $181.97
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $83.18 / $138.04
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $104.71 / $147.91
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$51.29 / $51.29 / $51.29
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $91.20 / $112.20
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $109.65 / $154.88