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Connecticut 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 $275 · 10th–90th $105–$4170%20%10th90th$275Professionalmedian $76 · 10th–90th $55–$1620%10%10th90th$76$50.0$100.0$200.0$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
$104.71 / $275.42 / $416.87
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $74.13 / $165.96
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$154.88 / $194.98 / $331.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $79.43 / $123.03
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$104.71 / $169.82 / $169.82
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $77.62 / $173.78
ConnectiCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$89.13 / $89.13 / $89.13
ConnectiCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $89.13 / $114.82
Health New England
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$50.12 / $263.03 / $269.15
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$83.18 / $83.18 / $83.18
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $87.10 / $123.03