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New Jersey 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 $58–$3550%10%20%10th90th$209Professionalmedian $78 · 10th–90th $55–$1700%20%10th90th$78$10.0$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
$57.54 / $208.93 / $354.81
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $75.86 / $169.82
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
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $169.82 / $169.82
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $75.86 / $120.23
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $114.82 / $114.82
Horizon BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $77.62 / $194.98
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$87.10 / $87.10 / $97.72
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $77.62 / $114.82