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See a sample rate comparisonCPT 97546 Fee Schedule
Last Verified: September 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.
Work Hardeningconditioning E, Work Hardeningconditioning Each Additional Hour (Listseparately In Addition To Code For Primary Procedure) Work Hardeningconditioning Each Additional Hour (List
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Physical Medicine and Rehabilitation Evaluations |
| Common Place of Service | 11 - Office 62 - Comprehensive Outpatient Rehab Facility |
| Common Modifiers | None GP - Services delivered under an outpatient physical therapy plan of care GO - Services delivered under an outpatient occupational therapy plan of care |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 97546 |
| Medicaid Fee Schedule | View Medicaid rates for 97546 |
National average reimbursement for CPT 97546 by major payers:
$62.69
$59.75
$48.36
$60.12
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CPT 97546
5 of 25 sample ratesHigher to lower in this preview
P. Daniel Le Grange
$399.64Published rateAnita Pairitz
Indiana University Health Southern Indiana Physicians
$73.40Published rateDeborah Couch
Loyola University Medical Center
$64.44Published rateRhonda Lampen
$56.84Published rateChristopher Raio
St Francis Hospital
$17.00Published rate
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See a sample payer proposalCPT 97546 vs. Other Physical Medicine and Rehabilitation Evaluations Codes
The CPT 97546 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 97546 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 97546. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 97546 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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