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Occupational Therapy Evaluation, Low Complexity

Maine 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 $162 · 10th–90th $95$3390%20%10th90th$162Professionalmedian $85 · 10th–90th $48$1950%10%10th90th$85$50.0$200.0$1.0K$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
$95.50
Median
$162.18
Typical High
$338.84
Aetna
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$66.07
Typical High
$95.50
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$102.33
Typical High
$186.21
Cigna
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$63.10
Typical High
$63.10
Cigna
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$109.65
Typical High
$234.42
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$134.90
Typical High
$208.93
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$95.50
Median
$128.82
Typical High
$338.84
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$83.18
Typical High
$173.78
United
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$109.65
Typical High
$199.53