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South Dakota 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
$91.50 / $91.50 / $115.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.45 / $71.55 / $120.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.06 / $93.39 / $107.69
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.55 / $102.78 / $196.05
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.31 / $80.37 / $170.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.70 / $141.25 / $168.69
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.35 / $125.45 / $201.19
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.79 / $146.13 / $196.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.31 / $80.16 / $155.81
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.20 / $137.30 / $161.50