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Massachusetts 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 $182 · 10th–90th $60–$3550%10%20%10th90th$182Professionalmedian $93 · 10th–90th $55–$2510%10%10th90th$93$50.0$200.0$1.0K$5.0K$20.0K

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
$60.26 / $141.25 / $436.52
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $77.62 / $229.09
AllWays Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $186.21 / $630.96
AllWays Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $114.82 / $281.84
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$165.96 / $213.80 / $275.42
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $120.23 / $120.23
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$89.13 / $89.13 / $295.12
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $85.11 / $229.09
Fallon Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$46.77 / $89.13 / $194.98
Fallon Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$46.77 / $85.11 / $162.18
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $117.49 / $257.04
Health New England
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$61.66 / $147.91 / $338.84
Health New England
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $58.88 / $181.97
Mass General Brigham
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $186.21 / $630.96
Mass General Brigham
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $114.82 / $281.84
Tufts
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $125.89 / $524.81
Tufts
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $53.70 / $117.49
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$69.18 / $97.72 / $97.72
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $100.00 / $269.15