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 97537 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.
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
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Physical Medicine and Rehabilitation Evaluations |
| Common Place of Service | 99 - Other POS 11 - Office |
| Common Modifiers | 59 - Distinct Procedural Service GO - Services delivered under an outpatient occupational therapy plan of care |
| Complexity Level | Low |
| Medicare Fee Schedule | $32.07 national non-facility rate (2026) · View Medicare rates for 97537 |
| Medicaid Fee Schedule | $24.70 median of the 7 states in the free preview · View Medicaid rates for 97537 |
National average reimbursement for CPT 97537 by major payers:
$39.21
$32.04
$29.74
$33.63
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 97537.
CPT 97537
5 of 25 sample ratesHigher to lower in this preview
Jamie Evans
$64.72Published rateSyed Waliuddin
Valley Psychiatry And Counseling LLC
$50.22Published rateShannon Jennings
Ottawa Regional Hospital & Healthcare Center
$34.40Published rateWanda Cegers
Tca Health Inc Nfp
$28.95Published rateChristopher Raio
Good Samaritan Hosptial Medical Center
$17.00Published 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 97537 vs. Other Physical Medicine and Rehabilitation Evaluations Codes
The CPT 97537 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 97537 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 |
|---|---|---|
| 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 |
| 97542-CPT | Low | Wheelchair Management/Propulsion Training |
| 97545-CPT | Low | Work Hardening/Condit Initial 2 Hrs |
| 97546-CPT | Low | Work Hardeningconditioning E, Work Hardeningconditioning Each Additional Hour (Listseparately In Addition To Code For Primary Procedure) Work Hardeningconditioning Each Additional Hour (List |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 97537. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 97537 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 97537) and we'll show you how you compare in 15 minutes or less.
Frequently Asked Questions
To find out the cost of a specific medical procedure, especially tailored to your location and the specific CPT code, you should utilize price transparency tools. We recommend using Payerprice's fee schedule lookup tool. It allows you to search with a CPT code and specific location to get estimated costs. Additionally, always contact your insurance provider and the healthcare facility directly for the most accurate information regarding your potential out-of-pocket expenses.
CPT stands for Current Procedural Terminology. CPT codes are standardized five-digit alphanumeric codes used by medical professionals, payers, and facilities to describe medical, surgical, and diagnostic services. They are fundamental to medical billing as they precisely identify the services rendered, which in turn determines how providers are reimbursed by insurance companies. When searching for procedure costs, knowing the CPT code is essential for obtaining accurate pricing information, for example, when using tools like Payerprice.
Healthcare prices for the same procedure can vary significantly due to multiple factors. These include the specific negotiated rates between providers and various insurance companies, overhead costs of the facility or practice, geographic location, the provider's expertise or specialization, the technology utilized, and whether the provider is in-network or out-of-network for a patient's insurance plan. The scope of services bundled into a procedure can also differ. Tools like Payerprice can help shed light on these varying costs by providing localized fee schedules.
No, health insurance plans typically do not cover 100% of all medical costs. Most plans involve out-of-pocket expenses such as deductibles (the amount you pay before your insurance starts covering costs), copayments (a fixed amount you pay for a service), and coinsurance (a percentage of the cost you pay after your deductible is met). Furthermore, some services might not be covered by your specific plan, or there might be limits on coverage. It's crucial to review your insurance policy documents and contact your insurer directly to understand your specific coverage details for any given service or procedure.
A 'billed charge' is the initial price that a healthcare provider or facility lists for a service or procedure, often the highest amount. This is typically not what anyone actually pays. A 'negotiated rate,' also known as an 'allowed amount' or 'contracted rate,' is the discounted price that an insurance company has agreed to pay a provider for a specific service. If you have insurance, your out-of-pocket costs (deductible, copay, coinsurance) are generally calculated based on this lower negotiated rate, not the higher billed charge. To understand these negotiated rates for various services and locations, resources like Payerprice's lookup tool can be very helpful.