Occupational therapy (therapeutic activities)
Facility: Ascension Via Christi Hospitals Wichita, Inc.
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $33
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.94x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Understanding this gauge: We use the federal Medicare rate of $35.07 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Saint Lukes Health Systems | $33 | 94% |
| Blue Cross Blue Shield | $33 | 94% |
| Humana | $33 | 94% |
| UnitedHealthcare | $33 - $91 | 94% |
| Va | $33 | 94% |
| Medicare (plans) | $33 | 94% |
| Vc Hope | $33 | 94% |
| Via Christi Research | $33 | 94% |
| Corizon | $41 | 117% |
| Smarthealth | $46 | 131% |
| Medicaid / KanCare | $55 | 157% |
| Mdsave | $70 | 200% |
| Coventry City Of Wichita | $77 | 220% |
| Aetna | $118 | 336% |
Consumer Guidance & Cost Commentary
For the CPT code 97530, representing occupational therapy therapeutic activities, the facility in Wichita, KS, has a negotiated rate of $33.00 across 14 payers, with most commercial plans ranging between $33 and $46. This negotiated amount is significantly lower than the facility's Medicare benchmark of $35.07, indicating that the facility is pricing at or below the federal government's cost-based standard for this service. While commercial rates generally average 200% to 300% of Medicare, this specific code shows a negotiated rate that is only 93% of the Medicare amount, suggesting a highly competitive pricing structure compared to typical commercial markups.
Patients should be aware that while cash-pay options are sometimes cheaper for those with high-deductible plans, the facility's data does not list a specific cash median or negotiated rate for self-pay. However, because the facility is a voluntary non-profit acute care hospital, it is recommended to contact the billing department directly to inquire about "self-pay" or "prompt-pay" discounts, which can range from 20% to 50% off the billed amount. Additionally, since the No Surprises Act prohibits balance billing for emergency care and non-emergency services at in-network facilities, patients can rest assured that they will not be billed for the difference between the facility's chargemaster and the insurance allowed amount for this covered service.