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Georgia 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 $98 · 10th–90th $66–$4070%20%10th90th$98Professionalmedian $81 · 10th–90th $58–$1660%20%10th90th$81$1.0$5.0$20.0$100.0$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
$66.07 / $104.71 / $407.38
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $79.43 / $169.82
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $85.11 / $141.25
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$93.33 / $134.90 / $162.18
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $109.65 / $218.78
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$60.26 / $70.79 / $97.72
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $81.28 / $154.88
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $114.82 / $275.42
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $131.83 / $141.25
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $97.72 / $144.54
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $83.18 / $138.04