go back

Occupational Therapy Evaluation, Low Complexity

North Carolina 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 $98 · 10th–90th $76$1620%20%10th90th$98Professionalmedian $78 · 10th–90th $60$1450%20%10th90th$78$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
Setting
Facility
Modifier
Global
Typical Low
$85.11
Median
$102.33
Typical High
$162.18
Aetna
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$77.62
Typical High
$144.54
BCBS
Setting
Facility
Modifier
Global
Typical Low
$93.33
Median
$112.20
Typical High
$204.17
BCBS
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$75.86
Typical High
$131.83
Cigna
Setting
Facility
Modifier
Global
Typical Low
$165.96
Median
$165.96
Typical High
$186.21
Cigna
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$77.62
Typical High
$138.04
Medcost
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$85.11
Typical High
$125.89
Medcost
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$70.79
United
Setting
Facility
Modifier
Global
Typical Low
$69.18
Median
$87.10
Typical High
$165.96
United
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$83.18
Typical High
$117.49
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$630.96
Median
$630.96
Typical High
$630.96
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$851.14
Typical High
$851.14