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Maryland 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
$74.18 / $199.15 / $965.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.29 / $78.33 / $342.00
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.87 / $82.87 / $82.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.00 / $105.10 / $180.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.97 / $84.36 / $132.49
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.69 / $110.07 / $154.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.81 / $92.09 / $112.34
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.20 / $82.45 / $148.97