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Arizona 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.

Facilitymedian $209 · 10th–90th $81–$4170%10%10th90th$209Professionalmedian $81 · 10th–90th $58–$2570%10%10th90th$81$1.0$5.0$20.0$100.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $275.42 / $416.87
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $79.43 / $257.04
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$67.61 / $239.88 / $489.78
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $79.43 / $151.36
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $57.54 / $81.28
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $93.33 / $158.49
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$69.18 / $97.72 / $194.98
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $87.10 / $380.19
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$69.18 / $112.20 / $151.36
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $87.10 / $125.89