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Occupational Therapy Evaluation, High Complexity

Tennessee 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.

How much does Occupational Therapy Evaluation, High Complexity cost?

$69.18

Typical physician fee. In Tennessee, July 2026.

Insurers have agreed to pay about $69.18 for this service. Most negotiated rates run $60.26 to $87.10.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 6 insurance carriers under federal price transparency rules.

How much rates vary

Professionalmedian $69 · 10th to 90th $54 to $132
$50.0$100.0$200.0$500.0professional $69

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$66.07
Typical High
$100.00
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$79.43
Typical High
$79.43
BCBS
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$77.62
Typical High
$154.88
Cigna
Setting
Professional
Modifier
Global
Typical Low
$37.15
Median
$83.18
Typical High
$154.88
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$851.14
Typical High
$851.14
United
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$81.28
Typical High
$95.50

Where Tennessee sits

The same service costs 2.8 times more in Alaska than in Kentucky. Every bar is a state, most expensive first. Pick one to see its carriers and full range.

Tennessee $69.18 · 48th of 51
AK $186KY $66.07

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.