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New Jersey 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
$74.13 / $269.15 / $724.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $75.86 / $288.40
AmeriHealth
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.88 / $389.05 / $812.83
AmeriHealth
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $107.15 / $114.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.18 / $162.18 / $162.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $75.86 / $131.83
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $114.82 / $134.90
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $77.62 / $194.98
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.10 / $97.72 / $107.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $81.28 / $107.15