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New York rates for HCPCS 97167

Occupational therapy evaluation, high complexity, requiring these components: An occupational profile and medical and therapy history, which includes review of medical and/or therapy records and extensive additional review of physical, cognitive, or psychosocial history related to current functional performance; An assessment(s) that identifies 5 or more performance deficits (ie, relating to physical, cognitive, or psychosocial skills) that result in activity limitations and/or participation restrictions; and Clinical decision making of high analytic complexity, which includes an analysis of the patient profile, analysis of data from comprehensive assessment(s), and consideration of multiple treatment options. Patient presents with comorbidities that affect occupational performance. Significant modification of tasks or assistance (eg, physical or verbal) with assessment(s) is necessary to enable patient to complete evaluation component. Typically, 60 minutes are spent face-to-face with the patient and/or family.

Professionalmedian $76 · 10th–90th $45–$2090%10%20%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
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $75.86 / $229.09
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $75.86 / $154.88
CDPHP
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $89.13 / $89.13
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $85.11 / $128.82
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $134.90 / $223.87
Excellus BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $112.20 / $186.21
Highmark BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $87.10 / $87.10
MVP Health Care
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $120.23 / $204.17
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$36.31 / $54.95 / $275.42
Univera
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $112.20 / $194.98