CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Texas Childrens Hospital North Austin Campus

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $113
Cash Discount Price: $118
vs. Medicare Baseline: 3.49x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Texas Childrens Hospital North Austin Campus is $113. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $118. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 3.49x the Medicare baseline. Located in 9835 North Lake Creek Parkway Bldg A, Austin, TX.

Cash / Self-Pay

$118

Average discount available for prompt cash payment at this facility.

Insurance Median

$113

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$32.4

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $32.4 (100%)

Cash / Self-Pay: $118 (364%)

Insurance Median: $113 (349%)

Cash: $118 (364% of Medicare)

Ins. Median: $113 (349% of 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 349% of the Medicare baseline (a markup of 249%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
First Care Health Plan	$48 - $113	148%
UnitedHealthcare	$48 - $113	148%
Driscoll Children'S Health Plan Mcd	$53	164%
Molina Mcd	$53	164%
Blue Cross Blue Shield	$62 - $111	191%
Community Health Choice	$62 - $113	191%
Community First Health Plan Mcd	$70	216%
Cook Children'S Health Plan	$70	216%
Cigna	$100 - $113	309%
Aetna	$113	349%
Kelseycare	$114	352%
Healthsmart	$123	380%
Evolutions Healthcare	$132	407%
First Health	$155 - $167	478%
Multiplan	$158	488%
Galaxy Health Network	$167	515%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $118.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97535.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Texas Childrens Hospital North Austin Campus is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97535.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.