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Occupational Therapy Evaluation, Low Complexity

Illinois 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 $158 · 10th–90th $81$3240%10%10th90th$158Professionalmedian $81 · 10th–90th $60$1260%10%20%10th90th$81$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
$81.28
Median
$151.36
Typical High
$309.03
Aetna
Setting
Professional
Modifier
Global
Typical Low
$56.23
Median
$75.86
Typical High
$117.49
BCBS
Setting
Facility
Modifier
Global
Typical Low
$134.90
Median
$234.42
Typical High
$741.31
BCBS
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$102.33
Typical High
$104.71
Cigna
Setting
Facility
Modifier
Global
Typical Low
$54.95
Median
$70.79
Typical High
$109.65
Cigna
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$87.10
Typical High
$158.49
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$144.54
Typical High
$269.15
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$134.90
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$32.36
Typical High
$33.11
United
Setting
Facility
Modifier
Global
Typical Low
$85.11
Median
$109.65
Typical High
$165.96
United
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$85.11
Typical High
$154.88