Occupational therapy (self-care training)
Facility: Ascension Via Christi Rehabilitation Hospital Inc
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $31
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.96x 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 |
|---|---|---|
| Vc Hope | $30 | 93% |
| Va | $30 | 93% |
| Humana | $30 | 93% |
| Medicare (plans) | $30 - $31 | 93% |
| UnitedHealthcare | $31 - $85 | 96% |
| Blue Cross Blue Shield | $31 | 96% |
| Smarthealth | $42 | 130% |
| Medicaid / KanCare | $51 | 157% |
| Aetna | $75 - $103 | 231% |
| Coventry City Of Wichita | $77 | 238% |
Consumer Guidance & Cost Commentary
For the Occupational therapy (self-care training) service at Ascension Via Christi Rehabilitation Hospital Inc in Wichita, KS, the negotiated rates paid by major payers range from $30 to $103, with a median negotiated amount of $31.00. This facility is a Part A provider and has established contracts with ten different insurance plans, including Medicare, UnitedHealthcare, and Aetna. While the median negotiated rate of $31.00 is slightly higher than the Medicare benchmark of $32.40 (a ratio of 1.0), it is important to note that commercial negotiated rates often include administrative overhead and contract dynamics that can inflate the baseline price. Patients should be aware that while in-network rates provide protection against balance billing, they may not always represent the lowest possible cost, particularly if a patient has a high deductible or is eligible for cash-pay options.
To maximize savings, patients should verify if the facility offers "self-pay" or "prompt-pay" discounts, which can significantly reduce the final bill by bypassing costly insurance claims processing. Since over 80% of hospital bills contain errors, it is advisable to request a full itemized CPT-coded bill before agreeing to any payment plan or signing consent waivers that might waive surprise billing protections. If a patient receives a bill that appears higher than expected, they should dispute it in writing with the billing supervisor rather than accepting a summary invoice, as this is the most effective way to identify unbundled codes or services not rendered. Ultimately, comparing the facility's rates directly to the Medicare benchmark provides a clear view of the true cost of care, helping patients make informed decisions about their financial responsibility.