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Occupational Therapy Evaluation, High Complexity

Virginia 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?

$81.28

Typical physician fee. In Virginia, July 2026.

Insurers have agreed to pay about $81.28 for this service. Most negotiated rates run $64.57 to $97.72.

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 8 insurance carriers under federal price transparency rules.

How much rates vary

Professionalmedian $81 · 10th to 90th $60 to $123
$50.0$200.0$1.0K$5.0Kprofessional $81

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
$53.70
Median
$70.79
Typical High
$100.00
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$85.11
Typical High
$120.23
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$97.72
Typical High
$199.53
Cigna
Setting
Professional
Modifier
Global
Typical Low
$58.88
Median
$85.11
Typical High
$154.88
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$107.15
Typical High
$125.89
Medcost
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$177.83
Typical High
$177.83
Medcost
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$107.15
Typical High
$107.15
Sentara
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$100.00
Typical High
$389.05
United
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$87.10
Typical High
$114.82

Where Virginia 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.

Virginia $81.28 · 24th 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.