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Wisconsin 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 $123 · 10th–90th $76–$4570%10%10th90th$123Professionalmedian $89 · 10th–90th $63–$2510%10%10th90th$89$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
$79.43 / $112.20 / $457.09
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $81.28 / $229.09
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $81.28 / $263.03
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$93.33 / $93.33 / $125.89
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $93.33 / $97.72
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $269.15 / $363.08
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $141.25 / $302.00
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$67.61 / $95.50 / $204.17
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $190.55 / $288.40
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $165.96 / $436.52
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $95.50 / $630.96
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $64.57
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$151.36 / $151.36 / $151.36
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $114.82 / $239.88
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $213.80 / $316.23
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $125.89 / $630.96
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $426.58 / $630.96
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Security Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$154.88 / $154.88 / $154.88
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $204.17 / $281.84
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$107.15 / $107.15 / $107.15
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $100.00 / $251.19