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Occupational Therapy Evaluation, High Complexity

Georgia 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.

How much does Occupational Therapy Evaluation, High Complexity cost?

$75.86

Typical physician fee. In Georgia, July 2026.

Insurers have agreed to pay about $75.86 for this service. Most negotiated rates run $64.57 to $93.33.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 8 insurance carriers under federal price transparency rules.

How much rates vary

Professionalmedian $76 · 10th to 90th $59 to $112
$50$100$200professional $76

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$56.23
Median
$70.79
Typical High
$100.00
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$79.43
Typical High
$79.43
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$87.10
Typical High
$141.25
CareSource
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$131.83
Typical High
$131.83
Cigna
Setting
Professional
Modifier
Global
Typical Low
$56.23
Median
$85.11
Typical High
$158.49
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$120.23
Typical High
$275.42
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$134.90
Typical High
$134.90
United
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$87.10
Typical High
$134.90

Where Georgia sits

The same service costs 2.8 times more in Alaska than in Kentucky. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Georgia· 32nd of 51

$75.86

AK $186KY $66.07

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.