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Colorado 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 $158 · 10th–90th $87–$3800%10%10th90th$158Professionalmedian $79 · 10th–90th $54–$1510%10%10th90th$79$2.0$10.0$50.0$200.0

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
$87.10 / $158.49 / $380.19
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $77.62 / $144.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$70.79 / $70.79 / $70.79
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $70.79 / $95.50
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $67.61 / $79.43
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $67.61 / $125.89
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $144.54 / $257.04
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $102.33 / $102.33
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$81.28 / $81.28 / $112.20
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $87.10 / $199.53