go back

North Carolina 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 $89 · 10th–90th $72–$2400%20%10th90th$89Professionalmedian $79 · 10th–90th $58–$1480%10%20%10th90th$79$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
$72.44 / $93.33 / $239.88
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $81.28 / $165.96
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $117.49 / $117.49
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$95.50 / $100.00 / $144.54
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $75.86 / $120.23
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $186.21 / $186.21
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $75.86 / $134.90
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $85.11 / $123.03
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $72.44 / $72.44
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $144.54 / $158.49
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$30.20 / $89.13 / $112.20
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $81.28 / $128.82
Wellcare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$630.96 / $630.96 / $630.96
Wellcare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$630.96 / $831.76 / $831.76