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Occupational Therapy Evaluation, Low Complexity

Massachusetts 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 $186 · 10th–90th $66$3720%10%10th90th$186Professionalmedian $102 · 10th–90th $56$3020%10%10th90th$102$50.0$200.0$1.0K$5.0K$20.0K

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
$58.88
Median
$181.97
Typical High
$426.58
Aetna
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$70.79
Typical High
$316.23
AllWays Health Partners
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$190.55
Typical High
$630.96
AllWays Health Partners
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$117.49
Typical High
$288.40
BCBS
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$223.87
Typical High
$302.00
BCBS
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$123.03
Typical High
$213.80
Cigna
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$89.13
Typical High
$316.23
Cigna
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$93.33
Typical High
$239.88
Fallon Health
Setting
Facility
Modifier
Global
Typical Low
$48.98
Median
$93.33
Typical High
$213.80
Fallon Health
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$89.13
Typical High
$165.96
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$120.23
Typical High
$269.15
Health New England
Setting
Facility
Modifier
Global
Typical Low
$69.18
Median
$213.80
Typical High
$323.59
Health New England
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$154.88
Typical High
$154.88
Mass General Brigham
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$190.55
Typical High
$630.96
Mass General Brigham
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$117.49
Typical High
$288.40
Tufts
Setting
Facility
Modifier
Global
Typical Low
$60.26
Median
$75.86
Typical High
$407.38
Tufts
Setting
Professional
Modifier
Global
Typical Low
$52.48
Median
$114.82
Typical High
$177.83
United
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$100.00
Typical High
$147.91
United
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$114.82
Typical High
$281.84