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Washington, DC 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 $240 · 10th–90th $93–$4470%20%10th90th$240Professionalmedian $78 · 10th–90th $54–$1320%10%10th90th$78$50.0$100.0$200.0$500.0$1.0K

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
$93.33 / $239.88 / $446.68
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $77.62 / $128.82
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $147.91 / $501.19
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $77.62 / $234.42
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $109.65 / $169.82
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$69.18 / $107.15 / $107.15
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $97.72 / $229.09