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Occupational Therapy Evaluation, High Complexity

West 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.

Professionalmedian $93 · 10th–90th $60$2140%20%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
$60.26
Median
$93.33
Typical High
$213.80
CareSource
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$100.00
Typical High
$154.88
Cigna
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$114.82
Typical High
$489.78
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$158.49
Typical High
$158.49
United
Setting
Professional
Modifier
Global
Typical Low
$61.66
Median
$87.10
Typical High
$131.83