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Occupational Therapy Evaluation, Low Complexity

California rates for HCPCS 97165

An occupational therapist assesses how a health condition, injury, or developmental issue affects a person's ability to manage everyday tasks like dressing, bathing, or working, then puts together a plan of care. This version applies to more straightforward cases, where the health history and the number of affected daily activities are relatively limited.

Rates data updated July 2026.

Facilitymedian $102 · 10th–90th $78$4370%10%10th90th$102Professionalmedian $93 · 10th–90th $63$3720%10%10th90th$93$50.0$100.0$200.0$500.0$1.0K$2.0K$5.0K

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
Setting
Facility
Modifier
Global
Typical Low
$83.18
Median
$245.47
Typical High
$537.03
Aetna
Setting
Professional
Modifier
Global
Typical Low
$61.66
Median
$93.33
Typical High
$380.19
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$123.03
Typical High
$562.34
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$77.62
Median
$95.50
Typical High
$239.88
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$102.33
Typical High
$257.04
Blue Shield
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$190.55
Typical High
$288.40
Blue Shield
Setting
Professional
Modifier
Global
Typical Low
$58.88
Median
$77.62
Typical High
$123.03
Cigna
Setting
Facility
Modifier
Global
Typical Low
$60.26
Median
$72.44
Typical High
$251.19
Cigna
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$93.33
Typical High
$181.97
Contra Costa Health
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$81.28
Typical High
$154.88
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$112.20
Typical High
$194.98
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$630.96
Typical High
$630.96
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$630.96
Typical High
$851.14
Molina
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$144.54
Optum
Setting
Professional
Modifier
Global
Typical Low
$30.90
Median
$39.81
Typical High
$70.79
Providence
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$107.15
Typical High
$165.96
Providence
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$95.50
Typical High
$181.97
Sutter Health Plus
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$302.00
Typical High
$302.00
United
Setting
Facility
Modifier
Global
Typical Low
$69.18
Median
$100.00
Typical High
$151.36
United
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$93.33
Typical High
$204.17