Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 97535 Fee Schedule
Last Verified: October 2026
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.
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
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Physical Medicine and Rehabilitation Evaluations |
| Common Place of Service | 11 - Office |
| Common Modifiers | 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 | $32.40 national non-facility rate (2026) · View Medicare rates for 97535 |
| Medicaid Fee Schedule | $26.40 median of the 7 states in the free preview · View Medicaid rates for 97535 |
National average reimbursement for CPT 97535 by major payers:
$39.90
$34.47
$30.40
$34.73
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 97535.
CPT 97535
5 of 25 sample ratesHigher to lower in this preview
Carrie Drake-Luecking
Indiana University Health Inc
$86.16Published rateStacey Occomy
Advocate Health And Hospitals Corporation
$54.33Published ratePamela Barron-Zambrano
Socal Anesthesia Solutions Inc
$35.53Published rateMarion Vamc
/ Marion Vamc
$34.56Published rateMerin Jacob
Texas Professional Hearing Center Inc
$26.21Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 97535 vs. Other Physical Medicine and Rehabilitation Evaluations Codes
The CPT 97535 code is part of the Medicine Services and 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 97535) and we'll show you how you compare in 15 minutes or less.