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Occupational Therapy Evaluation, Low Complexity

Texas 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 $132 · 10th–90th $63$4570%5%10th90th$132Professionalmedian $83 · 10th–90th $56$1230%20%10th90th$83$50.0$100.0$200.0$500.0$1.0K

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
$54.95
Median
$107.15
Typical High
$457.09
Aetna
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$72.44
Typical High
$125.89
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$123.03
Typical High
$123.03
BCBS
Setting
Facility
Modifier
Global
Typical Low
$93.33
Median
$234.42
Typical High
$457.09
BCBS
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$85.11
Typical High
$85.11
Baylor Scott & White
Setting
Facility
Modifier
Global
Typical Low
$95.50
Median
$112.20
Typical High
$275.42
Baylor Scott & White
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$100.00
Typical High
$151.36
Christus
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$97.72
Typical High
$97.72
Cigna
Setting
Facility
Modifier
Global
Typical Low
$54.95
Median
$64.57
Typical High
$85.11
Cigna
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$85.11
Typical High
$117.49
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$630.96
Median
$630.96
Typical High
$630.96
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$851.14
Typical High
$851.14
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$60.26
Median
$95.50
Typical High
$154.88
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$144.54
Typical High
$194.98
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$128.82
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$154.88
Typical High
$371.54
Providence
Setting
Facility
Modifier
Global
Typical Low
$58.88
Median
$91.20
Typical High
$151.36
Providence
Setting
Professional
Modifier
Global
Typical Low
$56.23
Median
$85.11
Typical High
$120.23
United
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$83.18
Typical High
$151.36
United
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$79.43
Typical High
$109.65
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$97.72
Typical High
$138.04