What every payer pays for 97165 in Pennsylvania
Across 11 commercial payers in Pennsylvania, the middle payer's median for 97165 (occupational therapy evaluation, level 1 of 3) is $84.50 per session. Pennsylvania Medicaid's fee-for-service rate, $61.73 per session, is 27% below that commercial median.
- Commercial median
- $84.50per session
- Pennsylvania Medicaid
- $61.73
- Medicare
- $96.52+
On this page
97165 in Pennsylvania, by payer type
Medicare's physician fee schedule pays $96.52–$103.53 in Pennsylvania across 2 localities.
Each payer's 97165 rate in Pennsylvania
Frequently asked questions
What do commercial payers pay for 97165 in Pennsylvania?
The median of 11 payers' medians is $84.50 per session, from 412 published rates in the October 2026 files.
How does Pennsylvania Medicaid compare with commercial insurance for 97165?
Pennsylvania Medicaid pays $61.73 per session, 27% below the commercial median.
What does Medicare pay for 97165 in Pennsylvania?
$96.52 to $103.53 on the RVU26B physician fee schedule (non-facility).
What does UnitedHealthcare pay for 97165 in Pennsylvania?
UnitedHealthcare's median is $81.02 per session, from 212 rates and 868 providers.
What does Horizon BCBS NJ pay for 97165 in Pennsylvania?
Horizon BCBS NJ's median is $83.27 per session, from 50 rates and 142 providers.