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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.

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	Facility/Professional	Modifier	Typical Low	Median	Typical High
Aetna Facility/Professional Facility Modifier Typical Low / Median / Typical High $69.18 / $147.91 / $398.11	Facility		$69.18	$147.91	$398.11
Aetna Facility/Professional Professional Modifier Typical Low / Median / Typical High $54.95 / $77.62 / $208.93	Professional		$54.95	$77.62	$208.93
Aetna Facility/Professional Professional Modifier CQ Typical Low / Median / Typical High $63.10 / $63.10 / $63.10	Professional	CQ	$63.10	$63.10	$63.10
BCBS Facility/Professional Facility Modifier Typical Low / Median / Typical High $77.62 / $95.50 / $239.88	Facility		$77.62	$95.50	$239.88
BCBS Facility/Professional Professional Modifier Typical Low / Median / Typical High $58.88 / $77.62 / $151.36	Professional		$58.88	$77.62	$151.36
Cigna Facility/Professional Facility Modifier Typical Low / Median / Typical High $57.54 / $79.43 / $316.23	Facility		$57.54	$79.43	$316.23
Cigna Facility/Professional Professional Modifier Typical Low / Median / Typical High $61.66 / $85.11 / $162.18	Professional		$61.66	$85.11	$162.18
United Facility/Professional Facility Modifier Typical Low / Median / Typical High $77.62 / $107.15 / $128.82	Facility		$77.62	$107.15	$128.82
United Facility/Professional Professional Modifier Typical Low / Median / Typical High $44.67 / $79.43 / $151.36	Professional		$44.67	$79.43	$151.36

Nationwide rates for HCPCS 97163

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