go back

Occupational Therapy Evaluation, Low Complexity

Wisconsin 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 $135 · 10th–90th $74$3310%10%10th90th$135Professionalmedian $95 · 10th–90th $69$2750%10%10th90th$95$20.0$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
$79.43
Median
$91.20
Typical High
$302.00
Aetna
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$89.13
Typical High
$218.78
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$81.28
Typical High
$263.03
CareSource
Setting
Facility
Modifier
Global
Typical Low
$95.50
Median
$95.50
Typical High
$128.82
CareSource
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$95.50
Typical High
$95.50
Cigna
Setting
Facility
Modifier
Global
Typical Low
$64.57
Median
$281.84
Typical High
$371.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$144.54
Typical High
$302.00
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$97.72
Typical High
$208.93
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$194.98
Typical High
$295.12
Medica
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$190.55
Typical High
$323.59
Medica
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$93.33
Typical High
$630.96
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$64.57
Network Health
Setting
Facility
Modifier
Global
Typical Low
$147.91
Median
$147.91
Typical High
$147.91
Network Health
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$117.49
Typical High
$245.47
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$97.72
Typical High
$208.93
Quartz
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$218.78
Typical High
$323.59
Quartz
Setting
Facility
Modifier
Global
Typical Low
$64.57
Median
$245.47
Typical High
$630.96
Quartz
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$446.68
Typical High
$630.96
Security Health
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Security Health
Setting
Facility
Modifier
Global
Typical Low
$151.36
Median
$151.36
Typical High
$151.36
Security Health
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$223.87
Typical High
$288.40
United
Setting
Facility
Modifier
Global
Typical Low
$83.18
Median
$109.65
Typical High
$109.65
United
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$97.72
Typical High
$257.04