What does Aetna pay for CPT 97165 in Los Angeles-Long Beach-Anaheim, CA?

The local peer median for CPT 97165 under Aetna in Los Angeles-Long Beach-Anaheim, CA is $100, based on 131 indexed providers. Modeled from published rates, not guaranteed.

What is the top of the local market (P90) for CPT 97165 under Aetna in Los Angeles-Long Beach-Anaheim, CA?

The P90, the top of the local market and Reddenda's target rate, is $153.

How does Aetna's rate for CPT 97165 compare to Medicare?

The Aetna local median of $100 is 99% of Medicare's national non-facility rate of $100.54 for CPT 97165.

Reddenda · Rate Intelligence · Los Angeles-Long Beach-Anaheim, CA

97165 under Aetna in Los Angeles-Long Beach-Anaheim, CA

Name: Aetna rates for CPT 97165 in Los Angeles-Long Beach-Anaheim, CA
Creator: Reddenda

OT evaluation, low complexity · Local peer median $100 · High confidence

$100 local peer median. In the Los Angeles-Long Beach-Anaheim, CA market, Aetna pays a local peer median of $100 for CPT 97165 (OT evaluation, low complexity), based on 131 providers in Reddenda's index of Aetna's own published in-network rates. The top of the local market, the P90 target, is $153, 53% above the median. A provider billed below the local median is being paid less than peers holding the identical Aetna contract in Los Angeles-Long Beach-Anaheim, CA for the identical code. Modeled from published rates, not guaranteed.

Local distribution · 131 providers · 131 rate records

P10

$73.01

P25

$76

Median

$100

P75

$140

P90 (target)

$153

P10$73.01

P25$76

Median (P50)$100

P75$140

P90 target$153

Peer basis: local peer distribution: same CPT, same payer file, same metro (CBSA) Benchmark: local peer median; never a national average Range: $47.54 – $260

The local peer median for CPT 97165 under Aetna in Los Angeles-Long Beach-Anaheim, CA is $100, drawn from 131 distinct providers.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Aetna to publish this rate
The bottom of the local market (P10) is $73.01 and the top (P90) is $153; the median-to-P90 spread is $53.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Aetna to publish this rate
The lowest published rate in this market is $47.54; the highest is $260.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Aetna to publish this rate
This benchmark is drawn from 131 individual rate records that Aetna itself published for this code in this metro.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Aetna to publish this rate
Medicare's national non-facility rate for CPT 97165 is $100.54, making the Aetna local median 99% of Medicare.Source: Medicare Physician Fee Schedule; the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Aetna to publish this rate
12.2% of indexed providers cluster at the single most common rate; the remainder shows a real, scoreable spread across the local market.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Aetna to publish this rate
A federal No Surprises Act arbitrator may weigh up to four plan years of a provider's own contracted rate history and local market share when resolving a payment dispute over this exact code and payer.Source: 45 CFR §149.510(c)(4)(iii)(B)

131 providers bill this code to this payer in this metro.

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This is the local market for CPT 97165 (OT evaluation, low complexity) under Aetna in Los Angeles-Long Beach-Anaheim, CA. Enter your NPI to see your own contracted rate against this peer curve, per payer and per code. Free, about 15 seconds, no card and no PHI.

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Documented reimbursement opportunity, modeled from published rates and never a guaranteed outcome.

Modeled from Aetna's own published in-network rates, never guaranteed and never a national average. Peer basis: same CPT, same payer file, same metro (CBSA). Federal citation for the underlying obligation: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Aetna to publish this rate. Page generated 2026-08-24 19:07 UTC; the live index is queried in real time on every request.