What is the top of the local market (P90) for CPT 97165 under Horizon Nj for Fort Collins-Loveland, CO providers?

The P90, the top of the local market and Reddenda's target rate, is $182.

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

The Horizon Nj local median of $148 is 147% of Medicare's national non-facility rate of $100.54 for CPT 97165.

Reddenda · Rate Intelligence · Fort Collins-Loveland, CO

97165 under Horizon Nj, for Fort Collins-Loveland, CO providers

Name: Horizon Nj rates for CPT 97165 among Fort Collins-Loveland, CO providers
Creator: Reddenda

OT evaluation, low complexity · Local peer median $148 · Medium confidence

$148 local peer median. Horizon Nj's published rate file lists a local peer median of $148 for CPT 97165 (OT evaluation, low complexity) among 109 indexed providers in Fort Collins-Loveland, CO. Where a Blue Cross entity’s label carries a state, that state names the file we found the rate in, not the provider’s location. Blue Cross plans file separately per state and do not share rates, even for the same provider. The top of that filed distribution, the P90 target, is $182, 23% above the median. A provider billed below this median is being paid less than peers holding the identical Horizon Nj contract for the identical code. Modeled from published rates, not guaranteed.

Local distribution · 109 providers · 109 rate records

P10

$148

P25

$148

Median

$148

P75

$148

P90 (target)

$182

P10$148

P25$148

Median (P50)$148

P75$148

P90 target$182

Peer basis: local peer distribution: same CPT, same payer file, same metro (CBSA) Benchmark: local peer median; never a national average Range: $121.72 – $212.66

The local peer median for CPT 97165 under Horizon Nj for Fort Collins-Loveland, CO providers is $148, drawn from 109 distinct providers.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Horizon Nj to publish this rate
The bottom of the local market (P10) is $148 and the top (P90) is $182; the median-to-P90 spread is $34.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Horizon Nj to publish this rate
The lowest published rate in this market is $121.72; the highest is $212.66.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Horizon Nj to publish this rate
This benchmark is drawn from 109 individual rate records that Horizon Nj itself published for this code in this metro.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Horizon Nj to publish this rate
Medicare's national non-facility rate for CPT 97165 is $100.54, making the Horizon Nj local median 147% of Medicare.Source: Medicare Physician Fee Schedule; the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Horizon Nj to publish this rate
79.8% 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 Horizon Nj 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)

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

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These are the rates Horizon Nj publishes for CPT 97165 (OT evaluation, low complexity) among Fort Collins-Loveland, CO providers. 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 Horizon Nj'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 Horizon Nj to publish this rate. Page generated 2026-08-24 20:13 UTC; the live index is queried in real time on every request.