Re-evaluation for occupational therapy, typically 30 minutes
Medicare pricing data for 4,233 providers across 50 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
Re-evaluation for occupational therapy, typically 30 minutes (HCPCS code 97168) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $70.30, but hospitals typically charge $147.65 — a 2.1x 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 $70.30, your out-of-pocket cost would be approximately $14.06. 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 2.1x more than what Medicare allows for this procedure. Medicare actually pays $54.27 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Alaska | $84 | $169 | 23 | 304 | +18.8% |
| District of Columbia | $79 | $188 | 14 | 173 | +11.8% |
| California | $76 | $127 | 349 | 5,519 | +8.2% |
| Connecticut | $76 | $180 | 24 | 105 | +7.8% |
| New York | $75 | $135 | 447 | 4,178 | +6.6% |
| New Jersey | $75 | $260 | 376 | 4,409 | +6.1% |
| Maryland | $73 | $137 | 127 | 2,216 | +4.5% |
| Massachusetts | $73 | $132 | 66 | 460 | +3.3% |
| Delaware | $71 | $154 | 26 | 152 | +1.2% |
| Rhode Island | $71 | $175 | 12 | 30 | +1.1% |
| Washington | $70 | $123 | 106 | 598 | +0.0% |
| Colorado | $70 | $149 | 134 | 970 | -0.4% |
| New Hampshire | $69 | $86 | 14 | 134 | -2.1% |
| Florida | $68 | $139 | 268 | 2,579 | -2.8% |
| Montana | $68 | $116 | 20 | 166 | -2.9% |
| North Dakota | $68 | $126 | 22 | 71 | -3.3% |
| Virginia | $68 | $154 | 89 | 1,107 | -3.3% |
| Wyoming | $68 | $122 | 26 | 216 | -3.4% |
| Pennsylvania | $68 | $146 | 206 | 1,924 | -3.9% |
| Illinois | $67 | $117 | 165 | 838 | -4.1% |
| Minnesota | $67 | $171 | 91 | 171 | -4.8% |
| Maine | $67 | $120 | 29 | 146 | -5.0% |
| Arizona | $67 | $143 | 114 | 1,565 | -5.1% |
| New Mexico | $66 | $119 | 15 | 59 | -6.2% |
| South Dakota | $66 | $103 | 18 | 58 | -6.2% |
| Georgia | $66 | $121 | 130 | 511 | -6.3% |
| Michigan | $66 | $133 | 82 | 479 | -6.5% |
| Oregon | $66 | $158 | 53 | 421 | -6.8% |
| Nebraska | $66 | $172 | 26 | 451 | -6.8% |
| Nevada | $65 | $179 | 47 | 359 | -6.9% |
| South Carolina | $65 | $108 | 47 | 284 | -7.3% |
| Wisconsin | $65 | $149 | 92 | 310 | -7.3% |
| Utah | $65 | $84 | 29 | 284 | -7.6% |
| Missouri | $65 | $116 | 76 | 523 | -7.6% |
| Ohio | $65 | $111 | 94 | 708 | -7.8% |
| Iowa | $65 | $115 | 42 | 462 | -8.0% |
| Indiana | $65 | $142 | 78 | 425 | -8.1% |
| Texas | $65 | $149 | 164 | 1,385 | -8.2% |
| Hawaii | $64 | $103 | 18 | 28 | -8.4% |
| Oklahoma | $64 | $114 | 13 | 37 | -8.4% |
| North Carolina | $64 | $112 | 100 | 767 | -8.4% |
| Idaho | $64 | $86 | 9 | 125 | -8.5% |
| Kansas | $64 | $123 | 34 | 245 | -8.7% |
| Louisiana | $64 | $96 | 51 | 592 | -9.0% |
| West Virginia | $64 | $76 | 7 | 46 | -9.2% |
| Alabama | $63 | $117 | 59 | 389 | -9.8% |
| Tennessee | $63 | $146 | 79 | 471 | -9.8% |
| Arkansas | $63 | $113 | 34 | 180 | -11.0% |
| Mississippi | $62 | $105 | 35 | 289 | -11.6% |
| Kentucky | $61 | $82 | 47 | 519 | -13.4% |
⚠️ 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