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Pennsylvania 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
$65.86 / $126.61 / $354.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.11 / $68.53 / $254.40
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $57,255.43 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.04 / $93.43 / $155.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $65.00 / $113.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.34 / $86.88 / $153.63
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $60.00 / $110.00
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.10 / $434.02 / $905.75
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.02 / $86.12 / $86.37
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68.53 / $125.13 / $359.85
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.11 / $74.19 / $248.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.29 / $94.50 / $150.84
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $65.00 / $113.06
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.89 / $86.88 / $145.90
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.46 / $98.31 / $98.31
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.46 / $98.31 / $103.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.20 / $84.94 / $127.41