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Occupational Therapy Evaluation, High Complexity

Texas 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 $83 · 10th–90th $55$1120%20%10th90th$83$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
$112.20
BCBS
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$85.11
Typical High
$85.11
Baylor Scott & White
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$100.00
Typical High
$112.20
Cigna
Setting
Professional
Modifier
Global
Typical Low
$61.66
Median
$85.11
Typical High
$117.49
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$851.14
Typical High
$851.14
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$144.54
Typical High
$186.21
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$128.82
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$154.88
Typical High
$371.54
Providence
Setting
Professional
Modifier
Global
Typical Low
$56.23
Median
$85.11
Typical High
$120.23
United
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$79.43
Typical High
$109.65
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$97.72
Typical High
$138.04