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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.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.95 / $142.68 / $257.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.89 / $63.47 / $142.68
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.43 / $167.37 / $516.79
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.37 / $116.04 / $267.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.13 / $208.54 / $277.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.78 / $119.78 / $119.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.00 / $90.00 / $292.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.14 / $95.05 / $240.13
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$101.45 / $152.88 / $6,679.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.21 / $94.86 / $163.36
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.49 / $200.19 / $299.92
Health New England
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $145.94 / $697.00
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.00 / $59.00 / $180.07
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $225.88 / $516.79
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.66 / $99.32 / $633.66
Tufts
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.50 / $90.91 / $261.20
Tufts
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.16 / $70.62 / $128.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.59 / $97.52 / $218.40