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Occupational Therapy Evaluation, High Complexity

Pennsylvania 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.

Professionalmedian $78 · 10th–90th $56$2090%10%10th90th$78$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
$57.54
Median
$75.86
Typical High
$213.80
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$97.72
Typical High
$169.82
Cigna
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$91.20
Typical High
$165.96
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$134.90
Typical High
$162.18
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$107.15
Typical High
$177.83
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$83.18
Typical High
$83.18
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$58.88
Median
$75.86
Typical High
$158.49
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$85.11
Typical High
$89.13
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$38.02
Typical High
$100.00
United
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$87.10
Typical High
$128.82