Occupational therapy (self-care training)
Facility: Children'S Mercy South
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $97
- Cash Discount Price: $72
- vs. Medicare Baseline: 2.99x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 299% of the Medicare baseline (a markup of 199%). 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 | $20 - $100 | 62% |
| Healthy Blue | $22 - $86 | 68% |
| Medicaid / KanCare | $23 | 71% |
| Blue Cross Blue Shield | $61 - $110 | 188% |
| Cigna | $72 - $104 | 222% |
| Home State Health | $75 | 231% |
| Medica | $87 | 269% |
| Aetna | $89 - $101 | 275% |
| Quiktrip | $97 | 299% |
| Health Midwest Comprehensive Care | $97 | 299% |
| Orscheln | $97 | 299% |
| Nebraska Furniture Mart | $97 | 299% |
| Wellfit/Centrus | $97 | 299% |
| Centivo | $97 | 299% |
| Wppa Providrs Care | $97 | 299% |
| Humana | $99 | 306% |
| Coxhealth Network | $110 | 340% |
| Coventry Health Care Of Kansas | $110 | 340% |
| Mercy Health | $112 | 346% |
| Multiplan | $113 | 349% |
| American Healthcare Alliance | $127 | 392% |
| Healthlink | $131 | 404% |
| National Preferred Provider Network | $134 | 414% |
Consumer Guidance & Cost Commentary
For the CPT code 97535, representing occupational therapy self-care training, the gross charge at Children's Mercy South in Overland Park is $149.00. This facility is located in Kansas, and while specific state or county average data was not provided in the source material, the facility's cash median rate of $72.00 is significantly lower than the gross charge. The data indicates that commercial insurance negotiated rates vary widely across the 23 participating payers, ranging from a low of $20.00 with UnitedHealthcare to a high of $134.00 with the National Preferred Provider Network. Notably, the median negotiated rate across all payers is $97.00, which is higher than the cash price, suggesting that patients with high-deductible plans might save money by paying the cash rate directly, provided they secure a prompt-pay discount before scheduling.
When comparing pricing to federal benchmarks, the Medicare amount for this service is $32.40. The facility's cash rate of $72.00 represents a 3.0x markup relative to the Medicare amount, which is substantially higher than the typical fair pricing range of 120% to 150% of Medicare. Patients should 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, it does not apply to self-pay scenarios. To minimize costs, consumers should explicitly request a "self-pay" or "prompt-pay" discount prior to check-in and ensure they sign a waiver preventing automatic claims submission to their insurance, as this avoids the administrative overhead