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Texas 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 $141 · 10th–90th $63–$4270%5%10th90th$141Professionalmedian $79 · 10th–90th $58–$1350%20%10th90th$79$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
$63.10 / $144.54 / $426.58
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $74.13 / $162.18
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$87.10 / $218.78 / $416.87
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $83.18 / $83.18
Baylor Scott & White
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$89.13 / $109.65 / $109.65
Baylor Scott & White
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $109.65 / $154.88
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$95.50 / $102.33 / $102.33
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $64.57 / $85.11
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $77.62 / $117.49
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$630.96 / $630.96 / $630.96
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$630.96 / $831.76 / $831.76
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$58.88 / $95.50 / $190.55
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $81.28 / $177.83
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $128.82
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $97.72 / $363.08
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$57.54 / $91.20 / $151.36
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $77.62 / $117.49
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $77.62 / $144.54
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $74.13 / $112.20
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $97.72 / $97.72