Occupational therapy (self-care training)
Facility: Smith County Memorial Hospital
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $52
- Cash Discount Price: $60
- vs. Medicare Baseline: 1.60x 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 | 105% |
| Medicaid / KanCare | $38 - $65 | 117% |
| Multiplan-All Plans | $50 - $58 | 154% |
| Wppa-All Plans | $52 - $61 | 160% |
| Health Partners Of Ks Ppo-All Plans | $52 - $62 | 160% |
| UnitedHealthcare | $52 - $62 | 160% |
| Midlands Choice-All Plans | $52 - $62 | 160% |
Consumer Guidance & Cost Commentary
For the CPT code 97535, representing occupational therapy (self-care training), Smith County Memorial Hospital in Smith Center, KS, lists a cash median price of $60.00, which matches the facility's gross charge. This cash rate is significantly higher than the Medicare benchmark of $32.40, reflecting a markup of 1.6 times the federal baseline. While commercial payers negotiate rates ranging from $34 to $65 depending on the plan, these negotiated amounts often exceed the cash price. For patients with high-deductible plans, paying the $60.00 cash median directly may be more cost-effective than relying on insurance, which could result in a higher allowed amount that the patient must cover after their deductible is met.
To minimize costs, patients should proactively contact the hospital to inquire about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid upfront. It is also critical to request an itemized billing audit before finalizing payment, as summary bills often obscure individual charges and may include unbundled codes or services not rendered. Since over 80% of hospital bills contain errors, verifying the line-by-line details ensures you are not paying for unnecessary items. Finally, be aware that while the No Surprises Act protects against balance billing for emergency care and non-emergency services from out-of-network providers at in-network facilities, patients should still review their specific plan details to confirm coverage limits and avoid unexpected out-of-pocket expenses.