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Occupational Therapy Evaluation, High Complexity

South Dakota 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 $98 · 10th–90th $71$1860%10%10th90th$98$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
$63.10
Median
$72.44
Typical High
$97.72
Cigna
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$109.65
Typical High
$112.20
Medica
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$91.20
Typical High
$331.13
Midlands
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$128.82
Typical High
$151.36
Midlands
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$102.33
Typical High
$173.78
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$147.91
Typical High
$199.53
United
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$91.20
Typical High
$229.09
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$134.90
Typical High
$158.49