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Pennsylvania rates for HCPCS 97168

Re-evaluation of occupational therapy established plan of care, requiring these components: An assessment of changes in patient functional or medical status with revised plan of care; An update to the initial occupational profile to reflect changes in condition or environment that affect future interventions and/or goals; and A revised plan of care. A formal reevaluation is performed when there is a documented change in functional status or a significant change to the plan of care is required. Typically, 30 minutes are spent face-to-face with the patient and/or family.

Professionalmedian $52 · 10th–90th $38–$1260%10%20%10th90th$52$20.0$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
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.02 / $50.12 / $125.89
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $67.61 / $117.49
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.88 / $61.66 / $114.82
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$34.67 / $34.67 / $109.65
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $74.13 / $117.49
Highmark BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $56.23 / $56.23
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$40.74 / $51.29 / $109.65
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $43.65 / $89.13
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$36.31 / $66.07 / $309.03
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $61.66 / $89.13