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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.

Facilitymedian $282 · 10th–90th $74–$9550%20%10th90th$282Professionalmedian $78 · 10th–90th $55–$2140%20%10th90th$78$50.0$200.0$1.0K$5.0K$20.0K$100.0K

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
$74.13 / $281.84 / $954.99
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $77.62 / $229.09
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $87.10 / $93.33
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$72.44 / $72.44 / $181.97
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $83.18 / $138.04
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $104.71 / $147.91
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$51.29 / $51.29 / $51.29
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $91.20 / $112.20
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $109.65 / $154.88