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Washington 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 $138 · 10th–90th $85–$4570%10%10th90th$138Professionalmedian $95 · 10th–90th $58–$3240%10%10th90th$95$50.0$100.0$200.0$500.0$1.0K

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
$95.50 / $181.97 / $676.08
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $91.20 / $371.54
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $151.36 / $302.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $104.71 / $208.93
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$89.13 / $107.15 / $151.36
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $102.33 / $251.19
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$72.44 / $109.65 / $257.04
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $109.65 / $229.09
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $66.07
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$120.23 / $199.53 / $199.53
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $186.21 / $323.59
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $169.82 / $251.19
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $151.36 / $302.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $104.71 / $194.98
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
$77.62 / $87.10 / $218.78
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $109.65 / $208.93