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Occupational Therapy Evaluation, Low Complexity

Pennsylvania 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 $110 · 10th–90th $69$3390%20%10th90th$110Professionalmedian $74 · 10th–90th $56$3020%20%10th90th$74$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
$66.07
Median
$104.71
Typical High
$338.84
Aetna
Setting
Professional
Modifier
Global
Typical Low
$56.23
Median
$70.79
Typical High
$302.00
AmeriHealth
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$95.50
Typical High
$95.50
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$8,511.38
Typical High
$77,624.71
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$112.20
Typical High
$169.82
Cigna
Setting
Facility
Modifier
Global
Typical Low
$64.57
Median
$75.86
Typical High
$165.96
Cigna
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$93.33
Typical High
$165.96
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$134.90
Typical High
$138.04
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$107.15
Typical High
$169.82
Highmark BCBS
Setting
Facility
Modifier
Global
Typical Low
$162.18
Median
$263.03
Typical High
$436.52
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$83.18
Typical High
$93.33
Independence Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$95.50
Typical High
$95.50
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$69.18
Median
$104.71
Typical High
$323.59
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$77.62
Typical High
$165.96
Oscar Health
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$63.10
Typical High
$89.13
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$81.28
Typical High
$85.11
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$199.53
Typical High
$331.13
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$97.72
Typical High
$104.71
United
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$109.65
Typical High
$109.65
United
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$87.10
Typical High
$134.90