Occupational therapy (self-care training)
Facility: Phillips County Hospital
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $43
- Cash Discount Price: $40
- vs. Medicare Baseline: 1.33x 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 $32.4 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 |
|---|---|---|
| Blue Cross Blue Shield | $34 - $38 | 105% |
| UnitedHealthcare | $38 - $47 | 117% |
| Medicaid / KanCare | $47 | 145% |
| Health Partners-All Plans | $47 | 145% |
Consumer Guidance & Cost Commentary
For the Occupational therapy (self-care training) service at Phillips County Hospital in Phillipsburg, Kansas, the negotiated rates for in-network payers like Blue Cross Blue Shield and UnitedHealthcare range from $34 to $47, which is significantly higher than the facility's cash price of $40.00 and the median paid amount of $38.00. While commercial insurance contracts often include administrative overhead that inflates these rates, patients with high-deductible plans may find it more cost-effective to pay the cash price directly, especially since the cash rate is lower than the negotiated amounts for most insurers. It is important to verify your specific plan's deductible status before scheduling, as paying out-of-pocket can sometimes result in immediate savings compared to waiting for insurance reimbursement.
The facility's cash rate of $40.00 is also notably higher than the Medicare benchmark of $32.40, indicating a markup relative to the federal government's cost-based reimbursement standard. Although the facility is a Critical Access Hospital owned by the local government, patients should proactively request a "self-pay" or "prompt-pay" discount before check-in to potentially lower the bill further, as hospitals often offer fee reductions for upfront payment to bypass costly claims processing. To ensure you are receiving the best possible rate, always ask the billing department to classify your visit as self-pay and request a waiver of insurance submission, which prevents the hospital from submitting a claim that would void any cash discount agreement.