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Maine 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 $123 · 10th–90th $91–$1780%20%10th90th$123Professionalmedian $83 · 10th–90th $50–$1860%10%10th90th$83$50.0$200.0$1.0K$5.0K

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
$91.20 / $141.25 / $177.83
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $70.79 / $134.90
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $102.33 / $190.55
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$60.26 / $60.26 / $60.26
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $107.15 / $229.09
Community Health Options
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $102.33 / $186.21
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $141.25 / $204.17
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$91.20 / $117.49 / $141.25
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $83.18 / $151.36
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $112.20 / $199.53