CPT 97545: Work Hardening/Conditioning, First Two Hours

Commercial payers pay $235 on average nationally for this procedure.

CPT code 97545 describes the initial two-hour portion of a structured, individualized work hardening/conditioning program focused on restoring functional capacity and maximizing return-to-work ability; service type is work hardening/conditioning program and the typical site of service is an outpatient rehabilitation or occupational therapy clinic where progressive, job-specific activities and graded exercise are delivered under therapist or rehabilitation physician supervision.

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National Reimbursement Benchmarks

National commercial rates for CPT 97545 cluster around BUCA’s average commercial benchmark of $234.70, with variation across major payers. Blue Cross Blue Shield shows the highest dispersion and outliers, reflected in a wide IQR from $262.20 to $322.50 (IQR $60.30) and a high 90th percentile of $352.30, while Aetna’s distribution is much narrower (IQR $37.80). Cigna and UnitedHealth Group fall between those extremes: Cigna’s IQR runs from $112.50 to $212.30 (IQR $99.80) and UnitedHealth Group’s from $136.00 to $195.10 (IQR $59.10). BUCA’s commercial benchmark provides a mid-market anchor at $234.70.

Comparing P75 minus P25 as a simple dispersion metric, Blue Cross Blue Shield displays the widest spread at $60.30, indicating greater variability among contracted rates, while Aetna is the tightest at $37.80, suggesting more consistent pricing. UnitedHealth Group’s spread of $59.10 is close to Blue Cross Blue Shield’s, and Cigna’s larger spread of $99.80 signals the most pronounced middle-50% variability among the named national payers. These differences highlight meaningful variability in commercial reimbursement for this code.

National Payer Mean Reimbursement Rates

State Reimbursement Rates

State: Alaska1 / 51

Rate by payer

Clinical & Coding Specifications

Clinical Context

A 45-year-old warehouse employee with a history of chronic low back pain (M54.5) and intermittent right knee pain (M25.561) following a work-related lifting injury is referred for an initial work hardening/conditioning evaluation. The interdisciplinary team—led by a physical therapist—conducts baseline assessments including pain levels, range of motion, strength testing, functional capacity evaluation, and job task analysis. The patient completes the first two-hour session of a structured, individualized work hardening program (97545) focused on progressive tolerance to simulated job tasks, cardiovascular endurance, lifting and carrying techniques, and neuromuscular control. Documentation includes objective measures (repetition counts, weights, timed ambulation), patient response to activity, safety observations, and a plan for additional hours (97546) if indicated. Typical workflow steps include referral and authorization verification with payor (Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, Medicare), initial evaluation, two-hour treatment session billed with 97545, immediate post-session notes, and planned coordination with occupational therapy or physical medicine & rehabilitation if work simulation or medical management needs expand.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure

Related Modifiers

10 rows

Modifier	Description	When to Use
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
23	Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…	- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
26	Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…	- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
54	Modifier ‑54 (“Surgical care only”) is appended to a CPT surgical procedure when the reporting surgeon performs the intraoperative (surgical) component but does not furnish the preoperative and/or…	- Use modifier -54 when the reporting surgeon provided only the intraoperative (surgical) component of a procedure and preoperative and/or postoperative management has been or will be provided by…
55	Modifier –55 indicates the billing provider furnished only postoperative management for a procedure that has a global surgical period. According to AAPC, this modifier is appended to the same CPT…	- Use modifier -55 when billing the same CPT surgical code that has a 10- or 90-day global period and you, as a provider other than the original surgeon, furnished ONLY postoperative management (no…
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
80	CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…	- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
82	Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…	- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…

Related Provider Taxonomies

8 rows

Taxonomy Code
225100000X
225200000X
208100000X
156FX1101X
103TM1800X
347B00000X
207VM0101X
163WP1700X

Related ICD-10-CM Codes

22 rows

ICD-10-CM Code	Description
G56.01	Carpal tunnel syndrome, right upper limb
G56.11	Other lesions of median nerve, right upper limb
M19.071	Primary osteoarthritis, right ankle and foot
M24.221	Disorder of ligament, right elbow
M25.561	Pain in right knee
M25.562	Pain in left knee
M51.26	Other intervertebral disc displacement, lumbar region
M51.27	Other intervertebral disc displacement, lumbosacral region
M54.16	Radiculopathy, lumbar region
M54.2	Cervicalgia

Showing 1–10 of 22

Related Payer Policy Updates

Specialty: Neurology/Neurosurgery1 / 3

10 rows

Policy	Payer	Effective Date
Navigated Transcranial Magnetic Stimulation for Preoperative Brain Mapping	premerabluecrossofwashington	2027-02-05
Navigated Transcranial Magnetic Stimulation for Preoperative Brain Mapping	premerabluecrossofwashington	2027-02-05
Navigated Transcranial Magnetic Stimulation for Preoperative Brain Mapping	premerabluecrossofwashington	2027-02-05
Calcitonin Gene-Related Peptide (CGRP) Inhibitors: Vyepti (eptinezumab-jjmr)	Mass General Brigham Health Plan	2027-01-04
Clinical Review Criteria Intraoperative Neurophysiological Monitoring (IONM)	Kaiser Permanente	2027-01-01
Open Neuroplasty Lumbar Plexus	Cigna	2026-12-15
Laser Interstitial Thermal Therapy	Cigna	2026-11-15
Laser Interstitial Thermal Therapy	Cigna	2026-11-15
Remote Electrical Neuromodulation for Migraines (i.e., Nerivio®)	bcbsvermont	2026-11-01
Lumbar Microdiscectomy	univerahealthcare	2026-10-15

CPT 97110: Therapeutic Exercise

CPT-97112-NEUROMUSCULAR-REEDUCATION-THERAPEUTIC-EXERCISE

CPT 97112: Neuromuscular Reeducation

CPT-97113-AQUATIC-THERAPEUTIC-EXERCISES-15-MIN

CPT 97113: Aquatic Therapeutic Exercises, 15 Minutes

CPT-97116-THERAPEUTIC-EXERCISE-AND-GAIT-TRAINING

CPT 97116: Therapeutic Exercises, Gait Training, 15 Minutes

CPT-97124-THERAPEUTIC-MASSAGE-SOFT-TISSUE-MOBILIZATION

CPT 97124: Therapeutic Massage / Soft Tissue Mobilization

CPT-97129-COGNITIVE-THERAPY-ONE-ON-ONE-15-MINUTES

CPT 97129: One-on-One Cognitive Therapeutic Intervention, First 15 Minutes

CPT-97130-COGNITIVE-THERAPY-ADD-ON-15-MINUTE

CPT 97130: Therapeutic Cognitive Rehabilitation, 15-Minute Increment

CPT-97139-THERAPEUTIC-PROCEDURE-UNLISTED

CPT 97139: Unlisted Therapeutic Procedure

CPT-97140-MANUAL-THERAPY-PHYSICAL-THERAPY

CPT 97140: Manual Therapy for Soft Tissue and Joint Dysfunction

CPT-97150-GROUP-THERAPEUTIC-EXERCISE-SUPERVISION

CPT 97150: Group Therapeutic Procedures, Supervised Exercise

Showing 1–10 of 26

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

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State Reimbursement Rates

State: Alaska1 / 51

Rate by payer

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

CPT Code	Description	Relationship to This Procedure

Related Modifiers

10 rows

Modifier	Description	When to Use
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
23	Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…	- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
26	Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…	- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
54	Modifier ‑54 (“Surgical care only”) is appended to a CPT surgical procedure when the reporting surgeon performs the intraoperative (surgical) component but does not furnish the preoperative and/or…	- Use modifier -54 when the reporting surgeon provided only the intraoperative (surgical) component of a procedure and preoperative and/or postoperative management has been or will be provided by…
55	Modifier –55 indicates the billing provider furnished only postoperative management for a procedure that has a global surgical period. According to AAPC, this modifier is appended to the same CPT…	- Use modifier -55 when billing the same CPT surgical code that has a 10- or 90-day global period and you, as a provider other than the original surgeon, furnished ONLY postoperative management (no…
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
80	CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…	- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
82	Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…	- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…

Related Provider Taxonomies

8 rows

Taxonomy Code
225100000X
225200000X
208100000X
156FX1101X
103TM1800X
347B00000X
207VM0101X
163WP1700X

Related ICD-10-CM Codes

22 rows

ICD-10-CM Code	Description
G56.01	Carpal tunnel syndrome, right upper limb
G56.11	Other lesions of median nerve, right upper limb
M19.071	Primary osteoarthritis, right ankle and foot
M24.221	Disorder of ligament, right elbow
M25.561	Pain in right knee
M25.562	Pain in left knee
M51.26	Other intervertebral disc displacement, lumbar region
M51.27	Other intervertebral disc displacement, lumbosacral region
M54.16	Radiculopathy, lumbar region
M54.2	Cervicalgia

Showing 1–10 of 22

Related Payer Policy Updates

Specialty: Neurology/Neurosurgery1 / 3

10 rows

Policy	Payer	Effective Date
Navigated Transcranial Magnetic Stimulation for Preoperative Brain Mapping	premerabluecrossofwashington	2027-02-05
Navigated Transcranial Magnetic Stimulation for Preoperative Brain Mapping	premerabluecrossofwashington	2027-02-05
Navigated Transcranial Magnetic Stimulation for Preoperative Brain Mapping	premerabluecrossofwashington	2027-02-05
Calcitonin Gene-Related Peptide (CGRP) Inhibitors: Vyepti (eptinezumab-jjmr)	Mass General Brigham Health Plan	2027-01-04
Clinical Review Criteria Intraoperative Neurophysiological Monitoring (IONM)	Kaiser Permanente	2027-01-01
Open Neuroplasty Lumbar Plexus	Cigna	2026-12-15
Laser Interstitial Thermal Therapy	Cigna	2026-11-15
Laser Interstitial Thermal Therapy	Cigna	2026-11-15
Remote Electrical Neuromodulation for Migraines (i.e., Nerivio®)	bcbsvermont	2026-11-01
Lumbar Microdiscectomy	univerahealthcare	2026-10-15

CPT 97110: Therapeutic Exercise

CPT-97112-NEUROMUSCULAR-REEDUCATION-THERAPEUTIC-EXERCISE

CPT 97112: Neuromuscular Reeducation

CPT-97113-AQUATIC-THERAPEUTIC-EXERCISES-15-MIN

CPT 97113: Aquatic Therapeutic Exercises, 15 Minutes

CPT-97116-THERAPEUTIC-EXERCISE-AND-GAIT-TRAINING

CPT 97116: Therapeutic Exercises, Gait Training, 15 Minutes

CPT-97124-THERAPEUTIC-MASSAGE-SOFT-TISSUE-MOBILIZATION

CPT 97124: Therapeutic Massage / Soft Tissue Mobilization

CPT-97129-COGNITIVE-THERAPY-ONE-ON-ONE-15-MINUTES

CPT 97129: One-on-One Cognitive Therapeutic Intervention, First 15 Minutes

CPT-97130-COGNITIVE-THERAPY-ADD-ON-15-MINUTE

CPT 97130: Therapeutic Cognitive Rehabilitation, 15-Minute Increment

CPT-97139-THERAPEUTIC-PROCEDURE-UNLISTED

CPT 97139: Unlisted Therapeutic Procedure

CPT-97140-MANUAL-THERAPY-PHYSICAL-THERAPY

CPT 97140: Manual Therapy for Soft Tissue and Joint Dysfunction

CPT-97150-GROUP-THERAPEUTIC-EXERCISE-SUPERVISION

CPT 97150: Group Therapeutic Procedures, Supervised Exercise

Showing 1–10 of 26

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

`97546`	Work hardening/conditioning; each additional hour	Billed for each additional hour beyond the initial two hours provided under `97545` when continued structured conditioning is delivered.
`97110`	Therapeutic exercises	Used for focused exercise components (strength, endurance) that may be part of or adjunct to the work hardening program.
`97112`	Neuromuscular reeducation	Used for interventions addressing balance, coordination, and gait re-education within the work conditioning plan.
`97140`	Manual therapy techniques	Used for hands-on soft tissue and joint mobilization incorporated into the session to improve function and tolerance to activity.

CPT 97545: Work Hardening/Conditioning, First Two Hours

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National Reimbursement Benchmarks

CPT 97545: Work Hardening/Conditioning, First Two Hours

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National Reimbursement Benchmarks

State Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

References

State Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

References

CPT 97545: Work Hardening/Conditioning, First Two Hours

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National Reimbursement Benchmarks

CPT 97545: Work Hardening/Conditioning, First Two Hours

Sign up for cpt 97545 policy alerts

National Reimbursement Benchmarks

State Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

What does CPT 97545 cover and where is it typically delivered?

How is additional time billed if the patient needs more than the initial two hours?

What kinds of assessments and documentation are expected during the initial 97545 session?

Which diagnoses in the provided list commonly justify use of work hardening under 97545?

Which payers are noted as typical payor contacts for authorization and billing workflows?

References

State Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

What does CPT 97545 cover and where is it typically delivered?

How is additional time billed if the patient needs more than the initial two hours?

What kinds of assessments and documentation are expected during the initial 97545 session?

Which diagnoses in the provided list commonly justify use of work hardening under 97545?

Which payers are noted as typical payor contacts for authorization and billing workflows?

References