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Missouri 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 $107 · 10th–90th $71–$2450%10%20%10th90th$107Professionalmedian $81 · 10th–90th $52–$2510%10%10th90th$81$50.0$100.0$200.0$500.0

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
$70.79 / $107.15 / $288.40
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $83.18 / $288.40
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $54.95 / $147.91
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $104.71 / $158.49
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $70.79 / $91.20
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $79.43 / $186.21
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $95.50 / $223.87
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $83.18 / $630.96
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $107.15 / $144.54
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $77.62 / $123.03