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Occupational Therapy Evaluation, High Complexity

California rates for HCPCS 97167

This is a thorough evaluation performed by an occupational therapist to assess a patient's ability to perform daily activities, such as dressing, cooking, or work tasks, when the patient's condition involves multiple complicating factors. It typically includes a detailed history, standardized assessments, and clinical judgment to develop a treatment plan for a patient with a more complex presentation than a routine evaluation. This level reflects more time and clinical complexity than a basic evaluation.

Rates data updated July 2026.

Professionalmedian $87 · 10th–90th $60$3630%10%10th90th$87$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
Professional
Modifier
Global
Typical Low
$57.54
Median
$75.86
Typical High
$426.58
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$79.43
Typical High
$79.43
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$100.00
Typical High
$257.04
Blue Shield
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$83.18
Typical High
$131.83
Cigna
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$93.33
Typical High
$181.97
Contra Costa Health
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$81.28
Typical High
$154.88
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$112.20
Typical High
$194.98
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$851.14
Typical High
$851.14
Molina
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$144.54
Optum
Setting
Professional
Modifier
Global
Typical Low
$30.90
Median
$39.81
Typical High
$70.79
Providence
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$95.50
Typical High
$181.97
Sutter Health Plus
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$302.00
Typical High
$302.00
United
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$93.33
Typical High
$199.53