go back

Iowa 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.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.74 / $121.10 / $152.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.45 / $91.50 / $389.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.00 / $65.00 / $113.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.06 / $107.08 / $153.25
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.55 / $128.46 / $210.99
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.74 / $125.45 / $240.03
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.04 / $82.70 / $232.29
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$113.10 / $141.25 / $201.19
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.48 / $151.19 / $213.27
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.04 / $128.68 / $178.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.43 / $81.59 / $141.59
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.20 / $126.20 / $148.50