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Pennsylvania rates for HCPCS 97165

Occupational therapy evaluation, low complexity, requiring these components: An occupational profile and medical and therapy history, which includes a brief history including review of medical and/or therapy records relating to the presenting problem; An assessment(s) that identifies 1-3 performance deficits (ie, relating to physical, cognitive, or psychosocial skills) that result in activity limitations and/or participation restrictions; and Clinical decision making of low complexity, which includes an analysis of the occupational profile, analysis of data from problem-focused assessment(s), and consideration of a limited number of treatment options. Patient presents with no comorbidities that affect occupational performance. Modification of tasks or assistance (eg, physical or verbal) with assessment(s) is not necessary to enable completion of evaluation component. Typically, 30 minutes are spent face-to-face with the patient and/or family.

Facilitymedian $126 · 10th–90th $69–$2880%10%20%10th90th$126Professionalmedian $83 · 10th–90th $59–$3020%20%10th90th$83$20.0$100.0$500.0$2.0K$10.0K$50.0K

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
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$69.18 / $125.89 / $288.40
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $83.18 / $302.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $100.00 / $169.82
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $75.86 / $125.89
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $91.20 / $165.96
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $134.90 / $162.18
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $107.15 / $177.83
Highmark BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$162.18 / $245.47 / $446.68
Highmark BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $83.18 / $83.18
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$66.07 / $102.33 / $147.91
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $77.62 / $165.96
Oscar Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $63.10 / $89.13
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $85.11 / $89.13
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$37.15 / $39.81 / $186.21
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.88 / $38.02 / $104.71
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $109.65 / $109.65
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $87.10 / $128.82