CPT 97597 Physical Therapy/Rehab
Dbrdmt opn wnd 1st 20 cm/< Cost
Body System: Musculoskeletal
Medicare Facility Rate
$31
CMS PFS CY2026
Medicare Non-Facility Rate
$102
Office/clinic setting
Hospital Outpatient
$205
OPPS rate
Relative Value Units (RVUs)
Medicare payment = Total RVU × Conversion Factor ($33.40 for CY 2026)
0.75
Work RVU
0.13
Facility PE RVU
0.05
Malpractice RVU
3.04
Total RVU
Frequently Asked Questions
How much does Dbrdmt opn wnd 1st 20 cm/< cost?
The Medicare facility rate is $31. Commercial insurance typically pays 150-250% of Medicare rates (varies). Hospital outpatient rate: $205.
How much does Dbrdmt opn wnd 1st 20 cm/< cost without insurance?
Without insurance, you may pay the hospital's chargemaster rate, which is often 300-500% of Medicare. Ask about cash-pay discounts — many facilities offer 20-40% off for self-pay patients. The Medicare baseline for this procedure is $31.