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Michigan 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
$76.04 / $76.04 / $98.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.11 / $66.76 / $91.50
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.00 / $127.08 / $157.19
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.00 / $83.37 / $95.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.44 / $93.88 / $130.88
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.69 / $107.74 / $122.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.50 / $65.00 / $65.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.89 / $83.82 / $134.53
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$76.04 / $76.04 / $95.81
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.45 / $77.63 / $106.73
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.30 / $100.04 / $140.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.06 / $78.93 / $93.52