$31.45
Choose 97535 for training in personal self-care or home-management tasks. Choose 97537 for functional activities in community settings or work-related contexts.
On this page
CMS RVU26D · Effective 2026-10-01
97537 Reintegration training Medicare reimbursement rates in Wisconsin
Reports skilled, one-on-one training that helps a patient manage practical activities in community settings or prepare for participation in a work environment. Compare 97537 office and facility rates across CMS payment localities in Wisconsin.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 97537 in Wisconsin?
Wisconsin has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$31.17
1 of 1 localities have a supported rate.
Payment area: Wisconsin
One mapped payment locality.
Facility setting
No supported rate
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Physical therapy
About 97537: Community and work reintegration training
Reports skilled, one-on-one training that helps a patient manage practical activities in community settings or prepare for participation in a work environment.
A therapist works directly with the patient on functional skills needed outside the clinic, such as navigating public transportation, shopping, managing money, or carrying out tasks related to a work setting. Work-focused services may include analyzing job tasks or the work environment and training the patient to use adaptive equipment. Occupational therapists commonly provide this rehabilitation service; physical therapists may provide it when the training fits the plan of care. Activities address the patient’s functional goals rather than general exercise alone.
Report one unit for each 15 minutes of direct, one-on-one service. Documentation should identify the activity practiced, its connection to the patient’s functional goals, the skilled instruction or adaptation provided, and the treatment time. Distinguish community or work reintegration from self-care instruction, general therapeutic activities, and work-hardening programs based on the activity and purpose. The professional component modifier does not apply to this therapy service. When multiple therapy units are reported on the same day, CMS reduces practice expense for the second and later units.
CMS billing rules for 97537
- Professional and technical components
- Therapy service: the professional component modifier does not apply.
- Multiple procedures
- Therapy multiple procedure payment reduction: practice expense is reduced for the second and later therapy units on the same day.
Where the value comes from
- Work RVU0.48 · 50%
- Practice expense (office) RVU0.47 · 49%
- Malpractice RVU0.01 · 1%
10.7K
Medicare services in 2024 · #1438 by national volume
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.
97537 compared with similar codes
Office rates for Wisconsin, from the same CMS release.
$34.00
97530 covers functional therapeutic activities; 97537 is directed to practical community or work participation, such as transportation or work-task adaptation.
97545
No office rateWork hardening
97545 is for a work-hardening program. Use 97537 for separately provided community or work reintegration training, not the work-hardening service itself.
$30.21
97542 is specific to wheelchair management training. Use 97537 for broader community or work reintegration activities rather than wheelchair skills alone.
Compare 97537 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Wisconsin →
Office / nonfacility
$31.17
Facility
Unavailable
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 97537 in Wisconsin.
PPRRVU2026_Oct_nonQPP.csv
12,892
- Code
- 97537
- Physician work
- 0.48
- Practice expense
- 0.47
- Malpractice
- 0.01
GPCI2026.csv
111
- Locality
- Wisconsin
- Physician work
- 1.000
- Practice expense
- 0.958
- Malpractice
- 0.308
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.48 | × 1.000 | 0.4800 |
| Practice expense | 0.47 | × 0.958 | 0.4503 |
| Malpractice | 0.01 | × 0.308 | 0.0031 |
| Total RVUs | 0.9333 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Wisconsin$31.17
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.48 | 1 |
| Practice expense | 0.47 | 0.958 |
| Malpractice | 0.01 | 0.308 |
(0.48 × 1 + 0.47 × 0.958 + 0.01 × 0.308) × $33.4009 = $31.17
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
97537 billing questions
How does this differ from self-care training?
Use this code for skilled practice of community or work-related activities, such as transportation or job-task adaptation. Self-care training focuses on activities such as dressing, bathing, or other personal care tasks.
Is each unit 15 minutes?
Yes. Report one unit for each 15 minutes of direct, one-on-one training, supported by documentation of the activity and treatment time.
Can this be reported with therapeutic activities on the same day?
They may be reported when each service is distinct and separately supported. Document the reintegration task separately from the therapeutic activity and account for all treatment time.
Does a professional component modifier apply?
No. CMS identifies this as a therapy service for which the professional component modifier does not apply.
How does the therapy multiple procedure reduction affect payment?
For multiple therapy units on the same day, CMS reduces practice expense for the second and later units. The rule concerns practice expense.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
12,88997530,,Therapeutic activities,A,,0.44,0.60,,0.60,NA,0.01,1.05,1.05,7,XXX,0.00,0.00,0.00,5,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,89097533,,Sensory integration,A,,0.48,1.33,,1.33,NA,0.01,1.82,1.82,7,XXX,0.00,0.00,0.00,5,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,89197535,,Self care mngment training,A,,0.45,0.51,,0.51,NA,0.01,0.97,0.97,7,XXX,0.00,0.00,0.00,5,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,89297537,,Community/work reintegration,A,,0.48,0.47,,0.47,NA,0.01,0.96,0.96,7,XXX,0.00,0.00,0.00,5,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,89397542,,Wheelchair mngment training,A,,0.48,0.44,,0.44,NA,0.01,0.93,0.93,7,XXX,0.00,0.00,0.00,5,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,89497545,,Work hardening,R,,0.00,0.00,,0.00,,0.00,0.00,0.00,7,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,89597546,,Work hardening add-on,R,,0.00,0.00,,0.00,,0.00,0.00,0.00,7,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817
10902402,WA,99,REST OF WASHINGTON,1.013,1.053,0.761
11011402,WV,16,WEST VIRGINIA,1.000,0.869,1.431
11106302,WI,00,WISCONSIN,1.000,0.958,0.308
11203602,WY,21,WYOMING**,1.000,1.000,0.740
113"MAC Assignments as of November 22, 2023",,,,,,
114,,,,,,