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Occupational Therapy Evaluation, High Complexity

Washington 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?

$93.33

Typical physician fee. In Washington, July 2026.

Insurers have agreed to pay about $93.33 for this service. Most negotiated rates run $70.79 to $151.

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 9 insurance carriers under federal price transparency rules.

How much rates vary

Professionalmedian $93 · 10th to 90th $56 to $251
$50$100$200$500professional $93

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
$56.23
Median
$85.11
Typical High
$331.13
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$104.71
Typical High
$218.78
Cigna
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$104.71
Typical High
$257.04
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$107.15
Typical High
$229.09
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$67.61
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$173.78
Typical High
$251.19
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$104.71
Typical High
$194.98
United
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$93.33
Typical High
$239.88
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$114.82
Typical High
$218.78

Where Washington sits

The same service costs 2.8 times more in Alaska than in Kentucky. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Washington· 16th of 51

$93.33

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.