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Occupational Therapy Evaluation, High Complexity

Wisconsin 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 $93 · 10th–90th $69$2880%10%10th90th$93$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
$63.10
Median
$81.28
Typical High
$257.04
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$81.28
Typical High
$263.03
CareSource
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$95.50
Typical High
$95.50
Cigna
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$151.36
Typical High
$302.00
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$194.98
Typical High
$295.12
Medica
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$91.20
Typical High
$630.96
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$70.79
Network Health
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$117.49
Typical High
$245.47
Quartz
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$218.78
Typical High
$323.59
Quartz
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$446.68
Typical High
$630.96
Security Health
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Security Health
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$223.87
Typical High
$288.40
United
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$100.00
Typical High
$257.04