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California 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 $102 · 10th–90th $76–$4370%10%10th90th$102Professionalmedian $81 · 10th–90th $58–$3390%10%10th90th$81$50.0$100.0$200.0$500.0$1.0K$2.0K

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
$72.44 / $257.04 / $489.78
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $77.62 / $354.81
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $87.10 / $87.10
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $95.50 / $239.88
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $104.71 / $245.47
Blue Shield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $181.97 / $269.15
Blue Shield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $83.18 / $190.55
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$60.26 / $72.44 / $316.23
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $87.10 / $173.78
Contra Costa Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $104.71 / $162.18
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $109.65 / $190.55
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$630.96 / $630.96 / $630.96
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $630.96 / $831.76
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $70.79 / $141.25
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.90 / $39.81 / $70.79
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$61.66 / $104.71 / $162.18
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $87.10 / $186.21
Sutter Health Plus
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$281.84 / $281.84 / $281.84
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $97.72 / $302.00
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $87.10 / $194.98