CPT 97535 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | Physical Medicine and Rehabilitation Therapeutic Procedures Physical Medicine and Rehabilitation Evaluations |
| Common Place of Service | 11 - Office None |
| Common Modifiers | None GO - Services delivered under an outpatient occupational therapy plan of care GP - Services delivered under an outpatient physical therapy plan of care |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 97535 |
National average reimbursement for CPT 97535 by major payers:
$39.90
$34.47
$30.40
$34.73
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 97535 | $34.56 | 1225087786 - MARION VAMC | 351516418 - / MARION VAMC | IN | General Acute Care Hospital (282N00000X) |
United | 97535 | $32.15 | 1144240136 - SARAH ZYSKOWSKI | 381434090 - (MI) MCLAREN GREATER LANSING | MI | Psychiatry Physician (2084P0800X) |
United | 97535 | $66.98 | 1548794183 - ZACHARY COHEN | 561732213 - APPALACHIAN REGIONAL MEDICAL ASSOCIATES INC / BETTER NOW MEDICINE PLLC / CHILDRENS ORTHOPAEDICS OF ATLANTA PC | NC | Psychiatry Physician (2084P0800X) |
United | 97535 | $33.79 | 1033209846 - THOMAS EVANS | 770221609 - TULARE FAMILY PRACTICE | CA | Family Medicine Physician (207Q00000X) |
United | 97535 | $54.33 | 1215968755 - STACEY OCCOMY | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IN | Psychiatry Physician (2084P0800X) |
United | 97535 | $35.53 | 1801446208 - PAMELA BARRON-ZAMBRANO | 824843810 - SOCAL ANESTHESIA SOLUTIONS INC | CA | Single Specialty Group (193400000X) |
United | 97535 | $34.97 | 1982627675 - JOHN ABORDO | 942196086 - GOLDEN VALLEY HEALTH CENTERS | CA | Foot & Ankle Surgery Podiatrist (213ES0103X) |
United | 97535 | $35.01 | 1568522878 - PREMIER URGENT CARE A PROFESSIONAL MEDICAL CORPORATION | 30469964 - PATEL PULLIAM AND HUBLI A PROF | CA | Multi-Specialty Group (193200000X) |
United | 97535 | $28.83 | 1467775239 - ROBERT H SHAW M D A PROFESSIONAL CORP | 952799700 - ROBERT H SHAW M D A PROFESSIONAL CORP | CA | Single Specialty Group (193400000X) |
United | 97535 | $63.68 | 1982904082 - MICHAEL WIELEBA | 561732213 - APPALACHIAN REGIONAL MEDICAL ASSOCIATES INC / BETTER NOW MEDICINE PLLC / CHILDRENS ORTHOPAEDICS OF ATLANTA PC | NC | Professional Counselor (101YP2500X) |
United | 97535 | $42.11 | 1003140799 - TAMBER TASKONAK | 592579938 - AIROJEN CENTER INC / GLAUCOMA INSTITUTE OF NORTHERN NEW JERSEY LLC / ORTHO FLORIDA LLC | FL | Speech-Language Pathologist (235Z00000X) |
United | 97535 | $35.01 | 1801829411 - ELIZABETH SASAKI | 843897706 - VISALIA FAMILY MEDICINE GROUP INC | CA | Family Medicine Physician (207Q00000X) |
United | 97535 | $86.16 | 1326443169 - CARRIE DRAKE-LUECKING | 351955872 - (IN) INDIANA UNIVERSITY HEALTH INC | IN | Speech-Language Pathologist (235Z00000X) |
United | 97535 | $35.27 | 1720344229 - KERRY COOK | 541383504 - TOWN CENTER ORTHOPAEDIC ASSOCIATES, P.C. | VA | Medical Physician Assistant (363AM0700X) |
United | 97535 | $26.21 | 1952912123 - MERIN JACOB | 760645139 - (TX) TEXAS PROFESSIONAL HEARING CENTER INC | TX | Audiologist (231H00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 97535 vs. Other Physical Medicine and Rehabilitation Evaluations Codes
The CPT 97535 code is part of the Physical Medicine and Rehabilitation Therapeutic Procedures services used for Physical Medicine and Rehabilitation Evaluations. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 97535 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 97533-CPT | Low | Sensory Integrative Techniques, Sensory Integrative Techniques To Enhance Sensory Processing And Promote Adaptive Responses To Environmental Demands Direct (One On One) Patient Contact By The Provider Each 15 Minutes |
| 97535-CPT | Low | Self Care Mngment Training, Self Care Home Management Training Eg Activities Of Daily Living Adl And Compensatory Training Meal Preparation Safety Procedures And Instructions In Use Of Assistive Technology Devices Adaptive Equipment Direct One On One Contact Each 15 Minutes |
| 97537-CPT | Low | Community Work Reintegration, Community Work Reintegration Training Eg Shopping Transportation Money Management Avocational Activities And Or Work Environment Modification Analysis Work Task Analysis Use Of Assistive Technology Device Adaptive Equipment Direct One On One Contact Each 15 Minutes |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 97535. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 97535 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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