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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.

Facilitymedian $126 · 10th–90th $69–$3240%10%20%10th90th$126Professionalmedian $78 · 10th–90th $55–$3090%20%10th90th$78$10.0$50.0$200.0$1.0K$5.0K$20.0K

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
$69.18 / $125.89 / $323.59
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $77.62 / $323.59
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $93.33 / $169.82
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $75.86 / $125.89
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $89.13 / $162.18
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $131.83 / $158.49
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $112.20 / $173.78
Highmark BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $239.88 / $457.09
Highmark BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $87.10 / $87.10
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$66.07 / $100.00 / $147.91
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $75.86 / $158.49
Oscar Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $63.10 / $89.13
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $83.18 / $83.18
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$33.88 / $38.02 / $97.72
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.88 / $38.02 / $97.72
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $107.15 / $107.15
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $83.18 / $128.82