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Occupational Therapy Evaluation, High Complexity

North Carolina 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 $79 · 10th–90th $60$1450%20%10th90th$79$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
$74.13
Typical High
$102.33
BCBS
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$87.10
Typical High
$151.36
Cigna
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$77.62
Typical High
$138.04
Medcost
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$70.79
United
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$81.28
Typical High
$117.49
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$851.14
Typical High
$851.14