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Oregon 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 $91–$2750%10%20%10th90th$191Professionalmedian $95 · 10th–90th $58–$2630%5%10%10th90th$95$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
$91.20 / $239.88 / $407.38
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $83.18 / $288.40
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$50.12 / $104.71 / $114.82
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $104.71 / $263.03
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $204.17 / $251.19
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $107.15 / $229.09
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $162.18 / $245.47
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$114.82 / $169.82 / $199.53
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$74.13 / $100.00 / $190.55
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $131.83 / $251.19
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$147.91 / $269.15 / $407.38
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $158.49 / $295.12
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$107.15 / $107.15 / $154.88
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $87.10 / $204.17