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Vermont 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 $302 · 10th–90th $234–$3980%20%10th90th$302Professionalmedian $83 · 10th–90th $59–$2090%20%10th90th$83$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. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$234.42 / $302.00 / $389.05
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $83.18 / $208.93
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$229.09 / $288.40 / $398.11
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $107.15 / $120.23
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $89.13 / $144.54
MVP Health Care
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $123.03 / $371.54
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $112.20 / $112.20
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $112.20 / $199.53