CPT code 97546: Work hardening, each additional hour2026 Medicare rate & RVUs in Massachusetts
Report 97546 for each additional hour beyond the initial two-hour work-hardening service represented by 97545.
Medicare pays $0.00 for 97546 in the office in Massachusetts (Metropolitan Boston, MA). 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 97546 covers
97546 represents additional time in a structured work-hardening program that builds a patient’s capacity to resume job duties through progressively demanding, work-related tasks. Physical or occupational therapists commonly provide the service in an outpatient rehabilitation setting, using graded activity and work simulation tailored to documented job demands. It is used after the initial work-hardening period, not for general exercise or isolated functional activities alone.
Report each additional hour with 97545, which represents the initial two-hour work-hardening period. Documentation should show the skilled interventions, work-related goals, time spent, patient response, and why further work-hardening treatment was needed. Medicare payment is restricted to specific circumstances. This add-on is reported only with its primary service and is paid within that service’s global period. As a therapy service, it does not use the professional component modifier.
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.
Where 97546 pays more and less in Massachusetts
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Boston, MA | $0.00 | $0.00 |
| Rest of Massachusetts | $0.00 | $0.00 |
How the 97546 rate is calculated
Each of 97546’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 · 97546
RVUs × geographic indexes × conversion factor
Work0.00
0.00 RVUs× 1.000 GPCI
Practice expense0.00
0.00 RVUs× 1.000 GPCI
Malpractice0.00
0.00 RVUs× 1.000 GPCI
Adjusted RVUs
0.0000
Conversion factor
$33.4009
Medicare rate
$0.00
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 97546
The CMS indicators that decide how 97546 is paid alongside other services.
CMS payment indicators · 97546
Work hardening, each additional hour
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| 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
97546 without CQ · national office
$0.00
Work hardening, each additional hour
97546-CQ · Allowed amount unchanged
$0.00
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.
97546 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 97545Work hardeningInitial two hours
- 97545 represents the initial two-hour work-hardening period; 97546 captures each additional hour and must be paired with it.
- 97537Reintegration trainingCommunity or work skills
- 97537 focuses on community or work reintegration activities. Use 97546 only for additional time in a work-hardening program.
- 97530Therapeutic activitiesOne-on-one, each 15 minutes
- 97530 covers therapeutic activities, while 97546 is limited to added time in a structured work-hardening program.
97546 billing questions
How does 97546 relate to 97545?
97545 represents the initial two-hour work-hardening period. Report 97546 with 97545 for each additional hour.
Can 97546 be billed by itself?
No. It is an add-on and must be reported with 97545.
What time and treatment details should the note include?
Document the additional treatment time, skilled work-related activities, the patient’s response, and progress toward work-related goals.
Should modifier 26 be appended?
No. The professional component modifier does not apply to this therapy service.
Does Medicare pay 97546 in every work-hardening case?
No. CMS identifies coverage as restricted to specific circumstances, so payment depends on whether the applicable coverage requirements are met.
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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