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Nationwide rates for HCPCS 97163

Physical therapy evaluation: high complexity, requiring these components: A history of present problem with 3 or more personal factors and/or comorbidities that impact the plan of care; An examination of body systems using standardized tests and measures addressing a total of 4 or more elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions; A clinical presentation with unstable and unpredictable characteristics; and Clinical decision making of high complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 45 minutes are spent face-to-face with the patient and/or family.

Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $69.18 / $147.91 / $398.11	Facility		$69.18	$147.91	$398.11
Aetna Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $77.62 / $223.87	Professional		$54.95	$77.62	$223.87
Aetna Facility/Professional Professional Modifier CQ Low / Median / High Price $63.10 / $63.10 / $63.10	Professional	CQ	$63.10	$63.10	$63.10
BCBS Facility/Professional Facility Modifier Low / Median / High Price $77.62 / $95.50 / $239.88	Facility		$77.62	$95.50	$239.88
BCBS Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $75.86 / $144.54	Professional		$58.88	$75.86	$144.54
Cigna Facility/Professional Facility Modifier Low / Median / High Price $58.88 / $81.28 / $316.23	Facility		$58.88	$81.28	$316.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $85.11 / $162.18	Professional		$63.10	$85.11	$162.18
United Facility/Professional Facility Modifier Low / Median / High Price $77.62 / $97.72 / $107.15	Facility		$77.62	$97.72	$107.15
United Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $81.28 / $123.03	Professional		$64.57	$81.28	$123.03

Nationwide rates for HCPCS 97163

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