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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.

Facilitymedian $269 · 10th–90th $74–$7240%10%10th90th$269Professionalmedian $76 · 10th–90th $49–$1550%10%10th90th$76$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
$74.13 / $269.15 / $724.44
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $70.79 / $144.54
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $169.82 / $169.82
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $75.86 / $120.23
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $114.82 / $114.82
Horizon BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $77.62 / $194.98
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$87.10 / $87.10 / $97.72
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $77.62 / $112.20