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See a sample rate comparisonCPT 97542 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.
Wheelchair Management/Propulsion Training
| 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 59 - Distinct Procedural Service GP - Services delivered under an outpatient physical therapy plan of care |
| Complexity Level | Low |
| Medicare Fee Schedule | $31.06 national non-facility rate (2026) · View Medicare rates for 97542 |
| Medicaid Fee Schedule | $26.45 median of the 7 states in the free preview · View Medicaid rates for 97542 |
National average reimbursement for CPT 97542 by major payers:
$40.51
$32.36
$29.41
$33.71
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CPT 97542
5 of 25 sample ratesHigher to lower in this preview
Barbara Elleman
Childrens Hospital Medical Center
$77.98Published rateMeredith Kromalic
Orthopedic One, Inc.
$42.00Published rateMarie Fightmaster
Orthoalliance Mso, LLC
$32.61Published rateNash Dreyer
Trihealth G, LLC
$29.57Published rateRachel Lewis
Hopewell Health Centers Inc
$24.12Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 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.
| 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 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.
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Frequently Asked Questions
A Current Procedural Terminology (CPT) code is a five-digit number used by medical professionals, such as doctors, hospitals, and other healthcare providers, to describe and report medical, surgical, and diagnostic procedures and services to health insurance companies and other payers. These codes ensure uniform communication and billing across the healthcare industry.
To find the cost of a specific medical procedure, especially based on a CPT code and your specific location, you can utilize specialized tools designed for healthcare price transparency. Payerprice offers a fee schedule lookup tool that allows users to search with a CPT code and specific location to get detailed pricing information. This can help you understand potential costs before a procedure or compare prices between providers.
The 'billed amount' is the total charge for a service or procedure submitted by the healthcare provider to your insurance company. The 'allowed amount' (also known as the 'negotiated rate' or 'eligible expense') is the maximum amount your insurance company will pay for a covered service. Your insurance plan typically pays a portion of the allowed amount, and you are responsible for the rest (deductible, co-pay, co-insurance). Tools like Payerprice can help you understand these negotiated rates.
Medical costs can vary significantly due to several factors, including the specific healthcare provider or facility (e.g., hospital vs. outpatient clinic), geographic location, the complexity of the procedure, whether the provider is in-network or out-of-network, and the specific negotiated rates with different insurance companies. Different facilities have varying overheads, technology, and staffing costs, which contribute to price variations. Resources like Payerprice can help you compare costs across different providers and locations.
For understanding your medical bills, contacting your insurance provider or the billing department of your healthcare facility are good first steps. For comparing prices of specific medical procedures based on CPT codes and location, Payerprice offers a fee schedule lookup tool. This tool can provide insights into typical costs and negotiated rates, helping you make more informed decisions about your healthcare and understand potential out-of-pocket expenses.
Your health insurance significantly impacts the price you pay by negotiating discounted rates with healthcare providers (the 'allowed amount'). After these discounts, your plan will typically cover a portion of the cost, usually after you've met your deductible. You are then responsible for co-pays, co-insurance, and any costs exceeding the allowed amount, especially if you choose an out-of-network provider. Understanding your plan's benefits and using tools like Payerprice to see negotiated rates can help you estimate your out-of-pocket expenses.