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Ohio 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 $107 · 10th–90th $59–$2510%10%10th90th$107Professionalmedian $79 · 10th–90th $55–$1450%10%10th90th$79$1.0$5.0$20.0$100.0$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
$58.88 / $104.71 / $251.19
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $72.44 / $144.54
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $87.10 / $151.36
Aultcare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$66.07 / $131.83 / $131.83
Aultcare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $66.07 / $75.86
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$91.20 / $107.15 / $125.89
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $104.71 / $218.78
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $141.25 / $162.18
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $83.18 / $158.49
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$107.15 / $234.42 / $436.52
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $83.18 / $147.91
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $79.43
SummaCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $112.20 / $112.20
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $107.15 / $158.49
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $87.10 / $107.15
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $75.86 / $104.71