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Florida 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 $151 · 10th–90th $49–$3390%5%10%10th90th$151Professionalmedian $72 · 10th–90th $49–$1410%10%10th90th$72$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
$48.98 / $151.36 / $338.84
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $72.44 / $144.54
AvMed
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$69.18 / $79.43 / $97.72
AvMed
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $97.72 / $104.71
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$44.67 / $54.95 / $100.00
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $72.44 / $134.90
Florida Blue
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$33.88 / $48.98 / $64.57
Florida Blue
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$27.54 / $67.61 / $81.28
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $33.11
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$51.29 / $97.72 / $112.20
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $64.57 / $102.33
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $83.18 / $100.00