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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 $76.04 / $126.61 / $257.61	Facility		$76.04	$126.61	$257.61
Aetna Facility/Professional Professional Modifier Low / Median / High Price $55.29 / $74.19 / $142.16	Professional		$55.29	$74.19	$142.16
Aetna Facility/Professional Professional Modifier CQ Low / Median / High Price $89.46 / $89.46 / $89.46	Professional	CQ	$89.46	$89.46	$89.46
BCBS Facility/Professional Facility Modifier Low / Median / High Price $74.83 / $92.65 / $182.00	Facility		$74.83	$92.65	$182.00
BCBS Facility/Professional Professional Modifier Low / Median / High Price $63.84 / $78.94 / $133.19	Professional		$63.84	$78.94	$133.19
Cigna Facility/Professional Facility Modifier Low / Median / High Price $65.00 / $72.00 / $113.06	Facility		$65.00	$72.00	$113.06
Cigna Facility/Professional Professional Modifier Low / Median / High Price $61.97 / $85.66 / $132.49	Professional		$61.97	$85.66	$132.49
United Facility/Professional Facility Modifier Low / Median / High Price $300.00 / $300.00 / $300.00	Facility		$300.00	$300.00	$300.00
United Facility/Professional Professional Modifier Low / Median / High Price $68.64 / $84.94 / $123.18	Professional		$68.64	$84.94	$123.18

Nationwide rates for HCPCS 97163

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