CPT 97542 Fee Schedule
Last Updated: April 2025
Wheelchair Management/Propulsion Training
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 | • GO - Services delivered under an outpatient occupational therapy plan of care • 59 - Distinct Procedural Service • GP - Services delivered under an outpatient physical therapy plan of care |
| Complexity Level | Moderate |
National average reimbursement for CPT 97542 by major payers:
$40.51
$32.36
$29.41
$33.85
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 97542. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 97542 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.
CPT 97542 vs. Other Physical Medicine and Rehabilitation Evaluations Codes
The CPT 97542 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 97542 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.
| CPT Code | Complexity Level | Description |
|---|---|---|
| 97537 | 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) |
| 97542 | Low | Wheelchair Management/Propulsion Training |
| 97545 | Low | Work Hardening/Condit Initial 2 Hrs |
| 97546 | Low | Work Hardening/Conditioning; Each Additional Hour (List Separately In Addition To Code For Primary Procedure) |
See what providers are getting paid in 2024 for 97542:
CPT 97542 Fee Schedule & Reimbursement Rates
The CPT 97542 fee schedule varies by payer type. Below are Medicare rates for 2024 and average in-network rates by state across major payers:
| Code | Medicare Rate | Avg. Cigna National Rate | More Info |
|---|---|---|---|
| 97537 | $31.62 | $33.76 | |
| 97542 | $31.62 | $33.85 | |
| 97545 | $152.84 | ||
| 97546 | $61.02 | ||
| 97750 | $33.95 | $36.41 | |
| 97755 | $38.28 | $40.78 |
Reimbursement rates depend on provider contracts, region, and payer. Always verify rates with your insurance provider or medical billing department.
What is price transparency?
The Price Transparency Rule is a federal law that took effect in July 2022, requiring all commercial payers to publicly disclose their prices through machine-readable files (MRFs). In short, this regulation mandates that insurance companies make healthcare costs transparent to the public.
Our data comes directly from these insurer-posted MRFs, ensuring compliance with the Price Transparency Rule. While PayerPrice is working toward a future where providers and payers collaborate for 100% upfront price certainty, it's important to acknowledge that data limitations and occasional errors may exist.
Healthcare Price Transparency Rule
cms.govConsumer Guide To Healthcare Prices
aha.orgGlossary of Healthcare Terms
healthcare.govUnlock access to price transparency insights today.
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