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Occupational Therapy Evaluation, High Complexity

Maine 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 $89 · 10th–90th $48$1950%10%10th90th$89$50.0$100.0$200.0

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
$47.86
Median
$66.07
Typical High
$95.50
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$102.33
Typical High
$186.21
Cigna
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$109.65
Typical High
$234.42
Community Health Options
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$125.89
Typical High
$128.82
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$134.90
Typical High
$208.93
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$83.18
Typical High
$165.96
United
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$109.65
Typical High
$199.53