Evaluation for occupational therapy, typically 1 hour
Medicare pricing data for 4,319 providers across 51 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 1 hour (HCPCS code 97167) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $99.96, but hospitals typically charge $179.28 — a 1.8x 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 $99.96, your out-of-pocket cost would be approximately $19.99. 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 1.8x more than what Medicare allows for this procedure. Medicare actually pays $75.91 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Alaska | $123 | $239 | 13 | 46 | +23.4% |
| New York | $110 | $178 | 344 | 2,245 | +10.0% |
| California | $106 | $143 | 295 | 2,781 | +6.1% |
| New Jersey | $106 | $167 | 340 | 2,230 | +5.7% |
| Hawaii | $106 | $124 | 9 | 32 | +5.7% |
| Connecticut | $104 | $174 | 50 | 321 | +4.5% |
| Massachusetts | $104 | $232 | 58 | 336 | +4.5% |
| District of Columbia | $104 | $115 | 11 | 130 | +4.1% |
| Maryland | $104 | $153 | 118 | 645 | +3.7% |
| Rhode Island | $102 | $181 | 7 | 20 | +2.0% |
| Washington | $102 | $196 | 93 | 281 | +1.7% |
| Delaware | $101 | $211 | 24 | 175 | +1.5% |
| Texas | $101 | $176 | 169 | 1,116 | +0.8% |
| Illinois | $100 | $193 | 227 | 1,379 | +0.4% |
| New Hampshire | $99 | $189 | 22 | 146 | -0.6% |
| Virginia | $99 | $173 | 104 | 692 | -0.6% |
| Colorado | $99 | $170 | 113 | 798 | -0.7% |
| Montana | $99 | $194 | 21 | 146 | -0.7% |
| Pennsylvania | $99 | $163 | 219 | 1,447 | -0.8% |
| Florida | $99 | $172 | 258 | 1,883 | -0.9% |
| Oregon | $99 | $207 | 44 | 201 | -1.0% |
| North Dakota | $98 | $163 | 18 | 111 | -1.5% |
| Minnesota | $98 | $322 | 92 | 364 | -2.0% |
| Wyoming | $98 | $178 | 18 | 96 | -2.2% |
| Nevada | $97 | $235 | 45 | 362 | -2.5% |
| Maine | $97 | $142 | 43 | 159 | -2.6% |
| Arizona | $97 | $185 | 75 | 307 | -2.8% |
| Utah | $96 | $132 | 29 | 235 | -3.9% |
| Missouri | $95 | $157 | 62 | 297 | -4.8% |
| South Dakota | $95 | $246 | 13 | 66 | -4.8% |
| Wisconsin | $95 | $270 | 127 | 508 | -4.9% |
| North Carolina | $95 | $194 | 111 | 711 | -5.3% |
| Idaho | $95 | $125 | 8 | 32 | -5.4% |
| South Carolina | $95 | $191 | 76 | 615 | -5.4% |
| Ohio | $95 | $166 | 101 | 408 | -5.5% |
| Iowa | $94 | $175 | 48 | 214 | -5.6% |
| Michigan | $94 | $240 | 147 | 915 | -5.8% |
| Georgia | $94 | $190 | 125 | 723 | -6.0% |
| Nebraska | $94 | $217 | 38 | 165 | -6.1% |
| Oklahoma | $94 | $209 | 29 | 95 | -6.4% |
| New Mexico | $93 | $156 | 18 | 50 | -6.5% |
| Alabama | $93 | $127 | 32 | 316 | -6.6% |
| Indiana | $93 | $196 | 133 | 814 | -7.3% |
| Kentucky | $92 | $172 | 73 | 348 | -7.5% |
| Louisiana | $92 | $172 | 44 | 295 | -7.6% |
| Tennessee | $92 | $184 | 97 | 476 | -7.9% |
| Kansas | $92 | $148 | 47 | 294 | -8.1% |
| Mississippi | $92 | $153 | 49 | 415 | -8.2% |
| West Virginia | $90 | $138 | 17 | 91 | -10.1% |
| Arkansas | $88 | $204 | 45 | 204 | -11.5% |
| Puerto Rico | $87 | $88 | 2 | 40 | -13.2% |
⚠️ 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