Occupational therapy (therapeutic activities)
Facility: Trego County Lemke Memorial Hospital
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $77
- Cash Discount Price: $77
- vs. Medicare Baseline: 2.20x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 220% of the Medicare baseline (a markup of 120%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 |
|---|---|---|
| Humana | $44 | 125% |
| Tricare | $48 | 137% |
| Va Ccn - All Plans | $56 | 160% |
| UnitedHealthcare | $56 - $90 | 160% |
| Aetna | $56 - $81 | 160% |
| Medicaid / KanCare | $56 - $90 | 160% |
| Ambetter / Centene | $61 | 174% |
| Blue Cross Blue Shield | $78 | 222% |
| Health Partners - All Plans | $86 | 245% |
| Healthy Blue Mcaid - All Plans | $90 | 257% |
Consumer Guidance & Cost Commentary
For CPT code 97530, Occupational therapy (therapeutic activities), Trego County Lemke Memorial Hospital in Wakeeney, KS, lists a gross charge of $90.00. This rate is significantly higher than the facility's own cash median of $77.00 and the negotiated median of $77.00. When compared to the national benchmark, the facility's gross charge is 2.2 times the Medicare amount of $35.07. While commercial payers negotiate rates ranging from $44 to $90, with UnitedHealthcare and Medicaid/KanCare plans showing the widest spread, patients should be aware that cash-paying or self-pay options often result in lower out-of-pocket costs than using insurance, especially if the patient's plan has a high deductible or does not cover the service.
To minimize costs, patients should verify if the hospital offers a "prompt-pay" discount for upfront payment, which can bypass administrative fees and reduce the total bill. It is also important to request an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as double-billing or unbundled codes that can be corrected. Since this facility is a Critical Access Hospital with government-local ownership, patients should confirm their specific plan's allowed amount and check for any self-pay discounts prior to scheduling to ensure they are not balance billed for the difference between the insurer's allowed rate and the hospital's charges.