CPT 97546 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 • 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 |
National average reimbursement for CPT 97546 by major payers:
$62.69
$59.75
$48.36
$61.02
| 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 97546 | ||||||
United | 97546 | $49.15 | 1255692794 - MELISSA WAGNER-SCHUMAN | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Psychiatry Physician (2084P0800X) |
United | 97546 | $70.88 | 1518340231 - NAGA GUNTUPALLI | 363167726 - (IL) RIVERSIDE HEALTH SYSTEM | IL | Psychiatry Physician (2084P0800X) |
United | 97546 | $71.40 | 1801813266 - GREGG BEAN | 741671142 - (TX) SOUTH TEXAS RADIOLOGY GROUP, P.A. | TX | Diagnostic Radiology Physician (2085R0202X) |
United | 97546 | $64.44 | 1740201425 - JOSEPH DIVINCENZO | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | PA | Psychiatry Physician (2084P0800X) |
United | 97546 | $56.84 | 1760412621 - RHONDA LAMPEN | 811324691 | CA | Psychiatry Physician (2084P0800X) |
United | 97546 | $66.76 | 1144203753 - HAIDAR KABBANI | 464056262 | OH | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 97546 | $70.88 | 1639691090 - KELLY RHODES | 911780160 | IL | Psychiatry Physician (2084P0800X) |
United | 97546 | $41.68 | 1588012058 - ALEXANDRIA MELENDEZ-ZAIDI | 752668018 | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 97546 | $67.70 | 1295991701 - TRILOK SHAH | 391127163 - ASCENSION MEDICAL GROUP-FOX VALLEY WISCONSIN INC | IL | Psychiatry Physician (2084P0800X) |
United | 97546 | $70.88 | 1932272952 - MOHAMMED HOMSI | 452353153 - (IL) HOMSI PEDIATRIC NEUROLOGY INC | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 97546 | $399.64 | 1760502058 - P. DANIEL LE GRANGE | 943281660 | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 97546 | $46.02 | 1508922964 - COLLEEN BUHRFIEND | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 97546 | $60.25 | 1316237530 - MATHERS CLINIC LLC, MATHERS CLINIC | 300626803 - (IL) MATHERS CLINIC LLC | IL | Psychiatry Physician (2084P0800X) |
United | 97546 | $41.68 | 1588012058 - ALEXANDRIA MELENDEZ-ZAIDI | 752668018 | TX | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 97546 | $60.25 | 1962589390 - KATHLEEN KELLEY | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
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 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 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-CPT | Low | Wheelchair Management/Propulsion Training |
| 97545-CPT | Low | Work Hardening/Condit Initial 2 Hrs |
| 97546-CPT | Low | Work Hardening/Conditioning; Each Additional Hour (List Separately In Addition To Code For Primary Procedure) |
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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