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Pennsylvania 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.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.51 / $136.97 / $359.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.11 / $68.53 / $252.00
Aetna
Facility/Professional
Professional
Modifier
CQ
Low / Median / High Price
$57.12 / $57.12 / $57.12
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $57,255.43 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.04 / $93.43 / $155.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $65.00 / $113.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.34 / $86.88 / $154.86
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $60.00 / $110.00
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$133.44 / $309.38 / $445.84
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.11 / $81.70 / $86.37
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.51 / $142.66 / $376.95
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.61 / $74.19 / $224.00
Martin's Point
Facility/Professional
Professional
Modifier
CQ
Low / Median / High Price
$57.12 / $57.12 / $57.12
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.00 / $299.33 / $376.58
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.29 / $94.50 / $150.84
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $65.00 / $113.06
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.89 / $86.88 / $148.87
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.46 / $98.31 / $98.31
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.46 / $98.31 / $103.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.05 / $86.23 / $129.28