CPT 97535: Therapeutic Activities and Task-Specific Training
Medicare pays $34 and commercial payers pay $55 on average nationally for this procedure.
CPT code 97535 describes therapeutic instruction and training focused on task-specific activities to improve recovery from acute illness, delivered as one-on-one therapeutic activity sessions; service type: therapeutic activities/functional training; typical site of service: outpatient clinic or inpatient rehabilitation setting where a clinician provides direct patient instruction to restore functional mobility and daily living skills.
For related coverage guidance, see recent payer policy updates: Lumbar Microdiscectomy, Artificial Cervical Intervertebral Disc, Lumbar Decompression.
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National Reimbursement Benchmarks
National means for CPT 97535 show a clear split: Medicare’s mean is $33.6 versus BUCA’s commercial mean of $55.0, indicating BUCA pays about $21.4 more on average than Medicare. Blue Cross Blue Shield, Cigna, Aetna, and UnitedHealth Group all have mean rates that fall between these two, but closer inspection highlights that commercially negotiated averages are materially above Medicare’s reimbursement for this code.
Dispersion (P75 minus P25) highlights variability by payer: Aetna’s interquartile range is $43.2 ($67.6 - $24.0), Cigna’s is $44.9 ($80.8 - $34.9) and Blue Cross Blue Shield’s is $28.8 ($71.6 - $42.8). UnitedHealth Group is relatively tight with an IQR of $14.8 ($44.6 - $29.8), while BUCA’s IQR is $31.4 ($68.5 - $37.1). Medicare’s IQR is narrow at $2 ($34 - $32), reflecting much less regional spread compared with major commercial payers.