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Occupational Therapy Evaluation, High Complexity

Massachusetts 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?

$102

Typical physician fee. In Massachusetts, July 2026.

Insurers have agreed to pay about $102 for this service. Most negotiated rates run $67.61 to $170.

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 9 insurance carriers under federal price transparency rules.

How much rates vary

Professionalmedian $102 · 10th to 90th $55 to $269
$50$100$200$500professional $102

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
$47.86
Median
$67.61
Typical High
$257.04
AllWays Health Partners
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$117.49
Typical High
$288.40
BCBS
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$123.03
Typical High
$213.80
Cigna
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$93.33
Typical High
$239.88
Fallon Health
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$89.13
Typical High
$165.96
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$120.23
Typical High
$269.15
Health New England
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$75.86
Typical High
$75.86
Mass General Brigham
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$117.49
Typical High
$288.40
United
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$117.49
Typical High
$281.84

Where Massachusetts 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.

Massachusetts· 9th of 51

$102

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.