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Illinois 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 $141 · 10th–90th $81–$3980%5%10%10th90th$141Professionalmedian $83 · 10th–90th $58–$1510%10%10th90th$83$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
$79.43 / $131.83 / $389.05
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $75.86 / $165.96
Aetna
Facility/Professional
Professional
Modifier
CQ
Typical Low / Median / Typical High
$63.10 / $63.10 / $63.10
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$131.83 / $213.80 / $776.25
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $104.71 / $109.65
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $70.79 / $112.20
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $81.28 / $154.88
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $141.25 / $288.40
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $123.03 / $131.83
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $32.36 / $33.11
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $107.15 / $144.54
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $79.43 / $144.54