Occupational therapy (therapeutic activities)
Facility: Scott County Hospital
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $121
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 3.45x 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 345% of the Medicare baseline (a markup of 245%). 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 |
|---|---|---|
| UnitedHealthcare | $28 - $127 | 80% |
| Humana | $56 | 160% |
| Blue Cross Blue Shield | $57 | 163% |
| Wppa | $80 - $1,200 | 228% |
| Aetna | $121 | 345% |
Consumer Guidance & Cost Commentary
For CPT code 97530, Occupational therapy (therapeutic activities), Scott County Hospital in Scott City, KS, has a gross charge of $134.00. While the facility's negotiated rates with major payers like UnitedHealthcare and Humana range from $28 to $127, the cash median is not available in this dataset. It is important to note that cash-pay options can sometimes be more cost-effective for patients with high-deductible plans if the insurance negotiated rate exceeds the cash price. Since the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should proactively ask about "self-pay" or "prompt-pay" discounts before scheduling services to potentially lower their out-of-pocket costs.
When evaluating the cost of this service, it is crucial to compare rates against federal benchmarks rather than the hospital's inflated list price. The Medicare amount for this code is $35.07, which serves as the objective baseline for fair pricing. Commercial negotiated rates often average 200% to 300% of Medicare, though fair pricing is typically defined as 120% to 150% of this rate. If you receive a bill, you should request an itemized billing audit to identify errors, double-billing, or unbundled codes, as over 80% of hospital bills contain mistakes. Additionally, under the No Surprises Act, you are protected from balance billing for out-of-network providers at in-network facilities, so you should dispute any surprise bills immediately rather than paying them out of fear of credit damage.