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  5. /Case rate
CPT 97004

HC OT RE-EVALUATION

Reported by 4 hospitals in the network under the case rate methodology.

Filter by billing methodology

All methodologiesAggregated across all available billing methodologies for this code.Case rateCMS definition: a flat rate for a package of items and services triggered by a diagnosis, treatment, or condition for a designated length of time.Fee scheduleCMS definition: the payer-specific negotiated charge is based on a fee schedule — for example, a Medicare, Medicaid, commercial payer, or workers’ compensation fee schedule.Per diemCMS definition: the per day charge for providing hospital items and services.Percent of billed chargesCMS definition: the payer-specific negotiated charge is based on a percentage of the total billed charges for an item or service, which may vary depending on certain pre-determined criteria being met.OtherCMS definition: used when the standard charge methodology can’t be described by case rate, fee schedule, per diem, or percent of total billed charges.

Reflects a negotiated flat case rate paid per episode of care, rather than itemized charges.

National pricing summary

Low

$218

Average

$270

Median

$261

High

$340

Hospitals reporting this code

#HospitalLocation
1Catholic Health Initiatives ColoradoFrisco, CO$59$107$237$716$222
2Catholic Health Initiatives ColoradoPueblo, CO$72$275$285$686$179
3Catholic Health Initiatives ColoradoDurango, CO$62$182$218$626$160
4Catholic Health Initiatives ColoradoCanon City, CO$32$263$340$686$257

Look up this code directly

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