Evaluation for occupational therapy, typically 30 minutes
Medicare pricing data for 10,278 providers across 52 states
Note: These costs reflect the Medicare physician/supplier component. Hospital facility fees are billed separately and can be 2-5x the physician fee.
💡 What You Should Know
Evaluation for occupational therapy, typically 30 minutes (HCPCS code 97165) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $100.69, but hospitals typically charge $204.28 — a 2.0x markup. Prices vary significantly by state and provider.
🏷️ Typical Out-of-Pocket Cost
Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $100.69, your out-of-pocket cost would be approximately $20.14. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.
What Hospitals Charge vs. What Medicare Pays
Hospitals charge 2.0x more than what Medicare allows for this procedure. Medicare actually pays $76.00 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Alaska | $125 | $219 | 45 | 723 | +24.3% |
| District of Columbia | $112 | $253 | 24 | 379 | +11.7% |
| California | $110 | $212 | 732 | 14,263 | +9.1% |
| New York | $110 | $186 | 909 | 17,564 | +8.9% |
| New Jersey | $108 | $199 | 726 | 10,015 | +7.0% |
| Maryland | $107 | $218 | 240 | 4,146 | +5.9% |
| Connecticut | $107 | $194 | 158 | 2,187 | +5.9% |
| Massachusetts | $106 | $194 | 185 | 3,987 | +4.8% |
| Hawaii | $103 | $153 | 40 | 626 | +2.6% |
| Washington | $103 | $208 | 312 | 5,701 | +2.0% |
| Rhode Island | $102 | $190 | 37 | 689 | +1.3% |
| Colorado | $102 | $227 | 235 | 3,849 | +1.2% |
| Delaware | $101 | $341 | 45 | 1,111 | +0.2% |
| New Hampshire | $101 | $198 | 42 | 719 | -0.1% |
| Virginia | $101 | $198 | 260 | 5,175 | -0.1% |
| Illinois | $100 | $199 | 512 | 8,877 | -0.7% |
| Pennsylvania | $100 | $226 | 421 | 5,905 | -1.0% |
| Oregon | $99 | $225 | 128 | 2,019 | -1.3% |
| Nevada | $99 | $210 | 86 | 1,289 | -1.5% |
| Vermont | $99 | $123 | 11 | 174 | -1.6% |
| Minnesota | $99 | $277 | 321 | 5,735 | -1.9% |
| Wyoming | $99 | $165 | 52 | 1,173 | -2.0% |
| North Dakota | $99 | $222 | 52 | 987 | -2.1% |
| Montana | $98 | $173 | 44 | 666 | -2.3% |
| Arizona | $97 | $234 | 195 | 4,487 | -3.2% |
| South Dakota | $97 | $177 | 48 | 913 | -3.3% |
| Michigan | $97 | $190 | 263 | 2,537 | -3.3% |
| Texas | $97 | $206 | 336 | 5,207 | -3.5% |
| Florida | $97 | $220 | 644 | 13,246 | -4.0% |
| Missouri | $96 | $184 | 148 | 1,870 | -4.2% |
| Maine | $96 | $181 | 62 | 770 | -4.2% |
| North Carolina | $96 | $199 | 319 | 6,200 | -4.5% |
| Wisconsin | $96 | $236 | 261 | 2,588 | -4.5% |
| Georgia | $96 | $204 | 313 | 5,130 | -5.0% |
| Utah | $96 | $168 | 60 | 391 | -5.1% |
| Idaho | $95 | $130 | 26 | 593 | -5.4% |
| Iowa | $95 | $203 | 115 | 1,467 | -5.9% |
| South Carolina | $95 | $185 | 201 | 4,193 | -5.9% |
| Indiana | $95 | $202 | 228 | 3,614 | -6.0% |
| Ohio | $95 | $172 | 238 | 3,659 | -6.1% |
| New Mexico | $94 | $153 | 30 | 731 | -6.2% |
| Oklahoma | $94 | $163 | 44 | 604 | -6.3% |
| Nebraska | $94 | $179 | 104 | 1,952 | -6.4% |
| Kansas | $94 | $213 | 81 | 1,525 | -6.8% |
| Louisiana | $93 | $174 | 147 | 2,767 | -7.2% |
| Tennessee | $93 | $203 | 237 | 3,306 | -7.6% |
| Kentucky | $93 | $172 | 128 | 1,722 | -7.7% |
| Alabama | $93 | $179 | 146 | 2,643 | -8.0% |
| Mississippi | $91 | $182 | 121 | 2,452 | -9.7% |
| Arkansas | $91 | $177 | 110 | 2,348 | -10.0% |
| West Virginia | $88 | $126 | 29 | 317 | -12.4% |
| Puerto Rico | $86 | $88 | 3 | 12 | -14.5% |
⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.
💊 Need post-procedure medications? Check costs on OpenPrescriber