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North Carolina rates for HCPCS 97166

Occupational therapy evaluation, moderate complexity, requiring these components: An occupational profile and medical and therapy history, which includes an expanded review of medical and/or therapy records and additional review of physical, cognitive, or psychosocial history related to current functional performance; An assessment(s) that identifies 3-5 performance deficits (ie, relating to physical, cognitive, or psychosocial skills) that result in activity limitations and/or participation restrictions; and Clinical decision making of moderate analytic complexity, which includes an analysis of the occupational profile, analysis of data from detailed assessment(s), and consideration of several treatment options. Patient may present with comorbidities that affect occupational performance. Minimal to moderate modification of tasks or assistance (eg, physical or verbal) with assessment(s) is necessary to enable patient to complete evaluation component. Typically, 45 minutes are spent face-to-face with the patient and/or family.

Facilitymedian $95 · 10th–90th $74–$2190%20%10th90th$95Professionalmedian $81 · 10th–90th $58–$1620%10%20%10th90th$81$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
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$83.18 / $100.00 / $229.09
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $79.43 / $173.78
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $102.33 / $144.54
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $87.10 / $144.54
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $186.21 / $186.21
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $75.86 / $134.90
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $85.11 / $128.82
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $70.79 / $70.79
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $147.91 / $162.18
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$87.10 / $87.10 / $114.82
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $83.18 / $120.23
Wellcare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$630.96 / $630.96 / $630.96
Wellcare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$630.96 / $851.14 / $851.14