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Idaho 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 $138 · 10th–90th $93–$2000%10%20%10th90th$138Professionalmedian $91 · 10th–90th $58–$1910%10%20%10th90th$91$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
$95.50 / $181.97 / $199.53
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $87.10 / $169.82
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$83.18 / $151.36 / $234.42
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $190.55 / $208.93
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$70.79 / $75.86 / $100.00
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $95.50 / $141.25
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$81.28 / $102.33 / $199.53
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $162.18 / $194.98
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $32.36 / $33.11
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$151.36 / $151.36 / $223.87
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $107.15 / $123.03
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $95.50 / $251.19
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $112.20 / $112.20
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $87.10 / $91.20