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Occupational Therapy Evaluation, Low Complexity

New York 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 $138 · 10th–90th $56$3800%10%20%10th90th$138Professionalmedian $78 · 10th–90th $45$2690%10%20%10th90th$78$10.0$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
$56.23
Median
$147.91
Typical High
$380.19
Aetna
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$77.62
Typical High
$338.84
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$85.11
Typical High
$154.88
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$89.13
Typical High
$89.13
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$89.13
Typical High
$89.13
Cigna
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$165.96
Typical High
$331.13
Cigna
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$85.11
Typical High
$134.90
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$34.67
Median
$112.20
Typical High
$257.04
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$120.23
Typical High
$223.87
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$123.03
Typical High
$138.04
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$112.20
Typical High
$186.21
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$87.10
Typical High
$87.10
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$50,118.72
Median
$53,703.18
Typical High
$75,857.76
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$120.23
Typical High
$204.17
United
Setting
Facility
Modifier
Global
Typical Low
$83.18
Median
$109.65
Typical High
$323.59
United
Setting
Professional
Modifier
Global
Typical Low
$36.31
Median
$54.95
Typical High
$281.84
Univera
Setting
Facility
Modifier
Global
Typical Low
$40.74
Median
$109.65
Typical High
$123.03
Univera
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$112.20
Typical High
$194.98