Estimated using RAND 2024 commercial-to-Medicare ratios. Actual prices vary by insurer, plan, and facility.
Top Providers in Texas
| Provider | Medicare | Services |
|---|---|---|
| Mueller, Kimberly MOT, OTR/L | $70.70 | 31 |
| Francis, Sarah OTR | $74.90 | 31 |
| Ojo, Esther OTD, OTR/L | $72.41 | 29 |
| Ruwaldt, Raymond OTR | $79.39 | 19 |
| Olson, Scott MD | $65.94 | 19 |
| Ramirez, Elisabeth OTR | $69.84 | 17 |
Texas Pricing in Context
In Texas, CPT code 97167 (Evaluation For Occupational Therapy, Typically 1 Hour) carries an average Medicare payment of $77.31 — 2% above the national benchmark of $75.91. 169 providers across the state submitted claims for this procedure in 2023, performing 1.1K total services. Individual payments in TX ranged from N/A at the low end to N/A at the high end, reflecting differences in provider setting (office vs. facility), modifiers, and the specific geographic locality code applied within the state.
The average billed charge in Texas is $176.36, which is the figure uninsured patients would most likely encounter before any negotiation or charity discount. Medicare, by statute, only reimburses the allowed amount — the balance between billed and paid is written off under provider participation agreements. Insured patients generally pay a negotiated rate that falls between these two figures; the exact amount depends on plan design, deductible status, and in-network participation. Because Texas sits above the national Medicare average, commercial rates in the state may also run higher than the US median.
Using RAND 2024 commercial-to-Medicare ratios for Medicine procedures, the estimated commercial insurance price in Texas lands near $231.76, with self-pay cash prices typically around $124.07. Before scheduling, patients can request a Good Faith Estimate under the No Surprises Act, compare cash rates from hospital Machine-Readable Files, and confirm whether the provider is in-network with their specific plan. This page presents CMS reference data for informational use; it does not constitute medical or financial advice.
Frequently Asked Questions
How much does Evaluation For Occupational Therapy, Typically 1 Hour cost in Texas?
The average Medicare payment for Evaluation For Occupational Therapy, Typically 1 Hour in Texas is $77.31, which is 2% above the national average of $75.91. Providers in TX typically bill $176.36 for this procedure.
What does Evaluation For Occupational Therapy, Typically 1 Hour cost with insurance in Texas?
With commercial insurance in Texas, Evaluation For Occupational Therapy, Typically 1 Hour costs an estimated $231.76. Without insurance, the estimated cash price is $124.07. These estimates are based on RAND 2024 commercial-to-Medicare ratios and vary by insurer, plan, and facility.
How many providers perform Evaluation For Occupational Therapy, Typically 1 Hour in Texas?
169 providers in Texas billed Medicare for Evaluation For Occupational Therapy, Typically 1 Hour in 2023, performing 1.1K total services. Medicare payments ranged from N/A to N/A depending on the provider.
Is Evaluation For Occupational Therapy, Typically 1 Hour cheaper in Texas than the national average?
No — Evaluation For Occupational Therapy, Typically 1 Hour costs 2% above the national average in Texas. The state average Medicare payment is $77.31 compared to $75.91 nationally. Factors like local cost of living, provider competition, and regional Medicare fee schedules all influence state-level pricing.
Related Guides
Related Data Sources
Data from CMS Medicare Physician & Other Practitioners (2023).
Read our methodology — how this data is sourced, computed, and verified.