How much does Medicare pay for CPT 97535?

Medicare allowed an average of $25.35 per service and paid $19.66 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $62.66, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 97535?

Training for self-care or home management, each 15 minutes. It was billed 3,689,997 times to 675,819 Medicare beneficiaries by 17,873 providers in 2024.

Does 97535 pay differently in an office than a hospital?

Yes. The allowed amount averaged $25.35 in an office setting and $23.94 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 97535 most?

Occupational Therapist in Private Practice, with 2,384,768 services from 5,485 clinicians. Next are Physical Therapist in Private Practice, Physical Medicine and Rehabilitation, Internal Medicine.

CPT 97535

Training for self-care or home management, each 15 minutes

$25.35Medicare-allowed amount per service, averaged across 3,689,997 services

Providers submitted

$62.66

Asking price, not received

Medicare allowed

$25.35

The fee schedule figure

Medicare paid

$19.66

Balance is patient coinsurance

Providers submitted an average of $62.66 for this code and Medicare allowed $25.35 — 2.5× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $19.66 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $25.35
Hospital / facility: $23.94

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 3,686,666 services were billed in an office setting and 3,331 in a facility.

Services: 3,689,997
Beneficiaries: 675,819
Providers billing it: 17,873
Total allowed: $93,541,424

What Medicare pays for CPT 97535

Across 3,689,997 services billed by 17,873 providers to 675,819 beneficiaries, Medicare allowed an average of $25.35 per service. That is 5.5 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 97535

Specialty	Services	Beneficiaries	Avg allowed	Providers
Occupational Therapist in Private Practice	2,384,768	186,770	$24.69	5,485
Physical Therapist in Private Practice	1,252,259	475,793	$26.55	12,087
Physical Medicine and Rehabilitation	11,886	2,722	$29.29	50
Internal Medicine	9,154	798	$23.13	15
Speech Language Pathologist	9,144	578	$25.37	17
Orthopedic Surgery	3,534	2,862	$25.43	69
Family Practice	3,465	1,141	$28.03	29
Nurse Practitioner	2,585	787	$23.66	22
General Practice	1,572	518	$34.16	2
Pain Management	1,366	220	$26.09	4
Neurology	1,352	224	$26.07	7
Pediatric Medicine	1,286	162	$32.93	1
Optometry	1,233	311	$25.78	11
Hand Surgery	808	617	$26.01	14
Otolaryngology	739	246	$29.25	3

97535 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
Florida	442,563	$24.01	$18.58	1,198
New York	379,858	$28.69	$20.28	1,676
California	361,512	$27.50	$19.55	1,615
New Jersey	304,762	$26.80	$19.45	1,496
Pennsylvania	187,455	$24.90	$19.26	750
Maryland	143,429	$25.87	$19.15	732
Illinois	142,938	$23.93	$18.54	524
Virginia	134,110	$24.69	$19.10	556
North Carolina	114,443	$23.44	$18.71	543
Massachusetts	108,081	$27.35	$19.93	625
Texas	100,967	$23.93	$18.77	609
Ohio	83,472	$23.29	$18.65	423
Arizona	73,322	$24.45	$19.08	653
Colorado	72,068	$25.52	$19.29	383
Missouri	68,293	$23.33	$18.63	186
Georgia	66,801	$23.90	$18.81	382
Tennessee	64,092	$23.26	$18.93	251
South Carolina	63,905	$23.38	$18.90	275
Michigan	60,728	$24.56	$19.01	652
Indiana	57,650	$23.49	$18.95	264
Kentucky	57,568	$23.11	$18.72	310
Wisconsin	51,715	$24.35	$19.48	229
Minnesota	46,579	$25.58	$19.78	473
Washington	44,947	$26.67	$19.52	327
Iowa	36,751	$23.50	$18.92	179
Alabama	34,140	$23.08	$18.89	317
Connecticut	32,087	$26.81	$19.80	260
Mississippi	28,081	$22.33	$18.47	93
Oklahoma	25,753	$22.68	$18.38	103
New Hampshire	25,334	$25.13	$19.18	145
Kansas	24,569	$22.85	$18.47	57
Delaware	24,335	$25.39	$19.45	124
Oregon	23,400	$25.34	$19.06	176
Louisiana	23,219	$24.22	$19.76	195
Maine	22,965	$24.78	$19.38	143
Arkansas	20,692	$23.01	$18.96	128
Nevada	17,934	$25.55	$19.90	115
Nebraska	16,770	$23.95	$19.38	60
Utah	16,624	$24.13	$18.78	97
West Virginia	14,362	$22.97	$18.64	63
Rhode Island	8,946	$26.30	$19.67	65
District of Columbia	8,457	$27.63	$19.52	54
North Dakota	7,635	$25.30	$19.45	30
South Dakota	7,532	$25.83	$20.26	38
Wyoming	7,243	$25.39	$19.44	37
New Mexico	6,571	$23.67	$18.62	46
Montana	6,301	$24.75	$19.16	49
Hawaii	5,467	$25.79	$19.28	50
Alaska	4,364	$26.99	$18.30	26
Vermont	4,151	$27.31	$20.87	46
Idaho	3,476	$23.30	$18.59	37
XX	922	$22.70	$18.83	1
AE	290	$26.41	$18.87	1
U.S. Virgin Islands	186	$28.01	$20.55	3
Puerto Rico	182	$23.53	$18.50	3

Related codes

97530Therapy procedure$31.54
97597Removal of tissue from wound$74.53
97533Therapy procedure$52.00
97598Removal of tissue from wound$33.10
97542Evaluation for wheelchair$23.83
97550Caregiver training in strategies and techniques to facilitate the pati$51.87
97537Training for community or work reintegration$24.91

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.