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Occupational Therapy Evaluation, High Complexity

Kentucky 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 $66 · 10th–90th $47$930%10%20%10th90th$66$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
Professional
Modifier
Global
Typical Low
$56.23
Median
$66.07
Typical High
$93.33
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$79.43
Typical High
$79.43
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$61.66
Typical High
$75.86
CareSource
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$112.20
Typical High
$141.25
Cigna
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$107.15
Typical High
$489.78
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$47.86
United
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$79.43
Typical High
$104.71