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Nebraska 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 $191 · 10th–90th $89–$3470%10%10th90th$191Professionalmedian $98 · 10th–90th $63–$3800%10%20%10th90th$98$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
$95.50 / $194.98 / $346.74
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $97.72 / $446.68
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$223.87 / $281.84 / $562.34
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $151.36 / $204.17
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $112.20 / $128.82
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $112.20 / $213.80
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$75.86 / $151.36 / $269.15
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $104.71 / $257.04
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $141.25 / $213.80
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $112.20 / $112.20
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $109.65 / $229.09
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $87.10 / $112.20
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $83.18 / $204.17