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Occupational Therapy Evaluation, High Complexity

New York 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 $76 · 10th–90th $45$2000%10%10th90th$76$10.0$20.0$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
$47.86
Median
$70.79
Typical High
$239.88
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$85.11
Typical High
$154.88
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$89.13
Typical High
$89.13
Cigna
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$85.11
Typical High
$134.90
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$120.23
Typical High
$223.87
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$112.20
Typical High
$186.21
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$87.10
Typical High
$87.10
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$120.23
Typical High
$204.17
United
Setting
Professional
Modifier
Global
Typical Low
$36.31
Median
$54.95
Typical High
$281.84
Univera
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$112.20
Typical High
$194.98