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Minnesota 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 $275 · 10th–90th $107–$4570%10%10th90th$275Professionalmedian $138 · 10th–90th $65–$2820%5%10%10th90th$138$50.0$100.0$200.0$500.0$1.0K

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
$154.88 / $316.23 / $363.08
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $81.28 / $245.47
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$91.20 / $162.18 / $323.59
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $229.09 / $288.40
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$263.03 / $446.68 / $575.44
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $109.65 / $173.78
Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$218.78 / $426.58 / $457.09
Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $85.11 / $138.04
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$91.20 / $177.83 / $316.23
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $128.82 / $316.23
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $107.15 / $112.20
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $91.20 / $288.40