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Indiana 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 $229 · 10th–90th $74–$3800%10%20%10th90th$229Professionalmedian $78 · 10th–90th $58–$1510%10%10th90th$78$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
$85.11 / $239.88 / $380.19
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $75.86 / $165.96
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$58.88 / $81.28 / $102.33
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $77.62 / $141.25
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$93.33 / $114.82 / $134.90
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $112.20 / $131.83
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $95.50 / $309.03
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $93.33 / $147.91
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$79.43 / $112.20 / $128.82
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $79.43 / $131.83