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New Mexico 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 $145 · 10th–90th $76–$1,0230%10%10th90th$145Professionalmedian $83 · 10th–90th $50–$2450%20%10th90th$83$50.0$200.0$1.0K$5.0K$20.0K$100.0K

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
$114.82 / $144.54 / $316.23
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $83.18 / $309.03
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$75.86 / $707.95 / $1,230.27
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $70.79 / $117.49
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $75.86 / $89.13
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $97.72 / $144.54
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $141.25
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$58.88 / $85.11 / $114.82
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $97.72 / $144.54
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $97.72 / $112.20
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $87.10 / $123.03