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 | • Medicine Services and 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 |
National average reimbursement for CPT 97535 by major payers:
$39.90
$34.47
$30.40
$35.93
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 97535 | ||||||
United | 97535 | $31.03 | 1568752665 - ANDREW KNOX | 362222696 - SWEDISHAMERICAN HOSPITAL | WI | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 97535 | $54.33 | 1215968755 - STACEY OCCOMY | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IN | Psychiatry Physician (2084P0800X) |
United | 97535 | $102.58 | 1942475678 - DANIEL BATEMAN | 222519596 - DARTMOUTH-HITCHCOCK CLINIC | IL | Psychiatry Physician (2084P0800X) |
United | 97535 | $63.91 | 1669678009 - NADIA MIRZA | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 97535 | $43.59 | 1831335850 - CLAUDINE SINSIOCO | 540620889 - INOVA HEALTH CARE SERVICES | VA | Psychiatry Physician (2084P0800X) |
United | 97535 | $33.50 | 1144203753 - HAIDAR KABBANI | 202305158 - TRIHEALTH G, LLC | OH | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 97535 | $31.03 | 1275564197 - PAUL BERKOWITZ | 363330928 - (IL) PRESENCE HEALTHCARE SERVICES | FL | Psychiatry Physician (2084P0800X) |
United | 97535 | $52.40 | 1033435557 - JESSICA NICHOLSON | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 97535 | $35.00 | 1457583924 - LINDSAY DUKE | 942854057 - IHC HEALTH SERVICES INC | UT | Speech-Language Pathologist (235Z00000X) |
United | 97535 | $27.44 | 1548454895 - | 742958277 - SCOTT & WHITE CLINIC | TX | Mental Health Counselor (101YM0800X) |
United | 97535 | $35.01 | 1801829411 - ELIZABETH SASAKI | 843897706 - VISALIA FAMILY MEDICINE GROUP INC | CA | Family Medicine Physician (207Q00000X) |
United | 97535 | $26.21 | 1952912123 - MERIN JACOB | 760645139 - (TX) TEXAS PROFESSIONAL HEARING CENTER INC | TX | Audiologist (231H00000X) |
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 | $26.01 | 1124457015 - TIFFANY PERAINO | 462847463 - FRENCH MEDICAL CORP | CA | Physician Assistant (363A00000X) |
United | 97535 | $33.68 | 1538504238 - WAKE FOREST HEALTH NETWORK LLC, ATRIUM HEALTH WAKE FOREST BAPTIST BEHAVIORAL MEDICINE - FSLR PEDIATRIC | 561935767 - (NC) WAKE FOREST HEALTH NETWORK, LLC | NC | Psychologist (103T00000X) |
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 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 To Enhance Sensory Processing And Promote Adaptive Responses To Environmental Demands Direct (One-On-One) Patientcontact Each 15 Minutes (Revised 01/01/13) |
| 97535-CPT | Low | Self-Care/Home Management Training (Eg Activitiesof 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 (Revised 01/01/13) |
| 97537-CPT | Low | 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 (Revised 01/01/13) |
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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