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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.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.65 / $90.65 / $162.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.29 / $64.29 / $163.19
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.83 / $102.43 / $162.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.12 / $60.12 / $60.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.14 / $92.35 / $196.35
Community Health Options
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.31 / $102.91 / $117.61
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $124.90 / $206.41
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.65 / $121.52 / $162.62
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.29 / $90.65 / $191.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.83 / $101.71 / $131.97