go back

Michigan 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 $79 · 10th–90th $76–$2140%20%10th90th$79Professionalmedian $78 · 10th–90th $58–$1780%10%10th90th$78$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
$75.86 / $79.43 / $213.80
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $77.62 / $186.21
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
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$93.33 / $134.90 / $169.82
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $87.10 / $87.10
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $77.62 / $117.49
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $97.72 / $112.20
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$53.70 / $53.70 / $64.57
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $85.11 / $229.09
Health Alliance Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$75.86 / $77.62 / $213.80
Health Alliance Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $79.43 / $165.96
Health Alliance Plan
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$120.23 / $120.23 / $120.23
Health Alliance Plan
Facility/Professional
Professional
Modifier
CQ
Typical Low / Median / Typical High
$57.54 / $57.54 / $57.54
Priority Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $70.79 / $117.49
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $97.72 / $97.72
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $79.43 / $112.20