CPT code 97530: Therapeutic activities, one-on-one, each 15 minutes2026 Medicare rate & RVUs in Washington
One-on-one therapy using dynamic functional tasks, such as transfers, lifting, and reaching, to improve daily performance, reported in 15-minute units.
Medicare pays $36.24–$40.29 for 97530 in the office in Washington, from Rest of Washington to King County, WA. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 97530 covers
This timed service involves direct, one-on-one treatment using dynamic activities that improve functional performance. A physical or occupational therapist may have a patient practice sit-to-stand transfers, lift and carry an object, squat to retrieve an item, or reach overhead for a household task. The activity is selected and adjusted to address the patient's functional limitation, rather than performed simply as an exercise repetition. Therapists and qualified therapy assistants furnish the service in outpatient practices, hospital outpatient departments, and skilled nursing facilities providing Part B therapy.
Report units from documented direct treatment minutes. Under Medicare's 8-minute rule, total minutes across timed therapy services determine the day's available units; when several services are furnished, allocate units according to the minutes spent on each. Document the activity, skilled intervention, treatment time, and connection to a functional goal. Use the appropriate therapy plan modifier and, when the assistant contribution meets Medicare's threshold, CQ or CO. Report the therapy service as a whole, without a professional-component modifier. Medicare reduces practice expense for the second and later therapy units on the same day.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Billing guides for 97530: 97110 vs 97530 · 97140 vs 97530 · Physical therapy CPT codes
Where 97530 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| King County, WA | $40.29 | Unavailable |
| Rest of Washington | $36.24 | Unavailable |
How the 97530 rate is calculated
Each of 97530’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 97530
RVUs × geographic indexes × conversion factor
Work0.44
0.44 RVUs× 1.000 GPCI
Practice expense0.60
0.60 RVUs× 1.000 GPCI
Malpractice0.01
0.01 RVUs× 1.000 GPCI
Adjusted RVUs
1.0500
Conversion factor
$33.4009
Medicare rate
$35.07
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 97530
The CMS indicators that decide how 97530 is paid alongside other services.
CMS payment indicators · 97530
Therapeutic activities, one-on-one, each 15 minutes
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 5 | Therapy reduction: practice expense of the second and later units is reduced. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 7 | Therapy service: the split doesn’t apply. |
What modifiers do to the payment
Modifier CQ · payment effect
With and without the modifier
97530 without CQ · national office
$35.07
Therapeutic activities, one-on-one, each 15 minutes
97530-CQ · Allowed amount unchanged
$35.07
Medicare cuts its own payment by 15% after the patient’s 20% coinsurance; the allowed amount stays the same. On $100 allowed: $20 coinsurance, then Medicare pays $68 instead of $80.
97530 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 97110Therapeutic exerciseOne-on-one, each 15 minutes
- Choose 97110 for exercises addressing strength, endurance, range of motion, or flexibility. Choose 97530 for dynamic performance of a functional task, such as transferring or lifting.
- 97535Self-care trainingADL and home management, per 15 minutes
- 97535 covers training in daily living skills, such as dressing, bathing, meal preparation, or adaptive equipment use. 97530 covers dynamic functional movement tasks such as transfers, lifting, and reaching.
- 97112Neuromuscular reeducationBalance, coordination, proprioception, timed
- 97112 focuses on neuromuscular reeducation of balance, coordination, or movement control. Choose 97530 when the skilled treatment centers on performing a dynamic functional task.
- 97150Group therapyTwo or more patients, per session
- 97150 covers therapy delivered simultaneously to two or more patients. 97530 requires direct, one-on-one contact and is reported in 15-minute units.
97530 billing questions
How is 97530 different from therapeutic exercise (97110)?
97110 covers exercises to improve strength, endurance, range of motion, or flexibility. Choose 97530 for a dynamic functional task, such as a transfer or lifting activity, with a documented functional goal.
How many units can be billed for a session?
If 97530 is the only timed therapy service, at least 8 minutes of direct treatment supports one unit under Medicare's 8-minute rule. When other timed services are furnished, total their direct minutes to determine available units, then allocate those units according to time spent on each service.
Can 97530 be billed with a therapy evaluation on the same day?
Yes, when the evaluation and a distinct skilled treatment are both performed and separately documented. Do not append modifier 59 or an X modifier solely because both occur on the same date.
Which therapy modifiers are used on Medicare claims?
Use GP or GO for treatment under the applicable physical or occupational therapy plan of care. Add CQ or CO when a physical therapist assistant or occupational therapy assistant, respectively, furnishes more than 10% of the service under Medicare's de minimis policy.
Can 97530 be billed when working with two patients at once?
97530 requires direct, one-on-one contact. Use 97150 for group therapy furnished simultaneously to two or more patients; separately documented individual treatment time may support 97530.
Does the multiple procedure reduction lower every unit?
The therapy unit with the highest practice expense is paid without the reduction. Medicare reduces practice expense for the second and later therapy units on the same day, whether they are additional 97530 units or other therapy services.
97530 is in these specialty bundles: Physical therapy
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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