90901 Medicaid reimbursement rate by state (2026)
Other therapy services. Medicaid pays a median of $31.90 for 90901 across 17 states, from $8.25 in Kansas to $105.32 in New Mexico.
- States publishing
- 17
- National median
- $31.90units vary by state
- Lowest
- $8.25Kansas
- Highest
- $105.32New Mexico
What does Medicaid pay for 90901?
17 state Medicaid programs publish a fee-for-service rate for 90901. The national median is $31.90 (units differ between states). New Mexico pays the most, $105.32 per visit, and Kansas the least, $8.25, a 12.8x spread. Where the billing unit matches Medicare's, Medicaid pays 271% of the 2026 Medicare physician fee schedule amount for the state.
Medicare (non-facility, 2026 physician fee schedule): $38.05–$46.86 depending on the state's Medicare locality.
90901 rate by state: highest, middle and lowest
One like-for-like fee-for-service rate per state, ranked. The workspace lists all 17 states with every variant, modifier and effective date.
How to read this table
- Order. States are listed from the highest published rate to the lowest. No single unit is shared by 8 or more states for 90901, so the order is by published amount and is not a like-for-like rank.
- Medicaid rate. The most the state's fee-for-service program pays for one unit, as published. 11 of the 17 states list more than one rate for 90901, by modifier, provider type or setting; the table shows the one that matches the provider level and setting used across states, without add-ons.
- Unit. Of the 17 states, 1 publish 90901 per visit, and 16 schedules print no unit at all (a flat amount per service).
- Per hour. 90901 is not billed in time units in these states, so no hourly figure is shown.
- Managed-care plans. The rule the state sets for its plans on this rate. What each rule means is explained below.
- % of Medicare. Shown only where the Medicaid rate uses the code's own billing unit and a Medicare amount exists: 1 state for 90901, at 271%.
- Source and date. Each Source link opens the state's own document; “since” is the date the rate took effect.
Why 90901 rates differ between states
Published rates for 90901 run from $8.25 in Kansas to $105.32 in New Mexico. The two publish it in different units (visit versus no unit printed), so part of that gap is the unit rather than the price. Half the states pay more than the median of $31.90 and half pay less. The usual reasons for a spread like this in therapy (PT/OT/speech) rates:
- States pay therapy by CPT code, but many pay therapy assistants a reduced percentage and some pay differently in outpatient hospital, private practice and home settings.
- Children's therapy is driven by the EPSDT benefit, so some states maintain separate pediatric rates or programs.
- Visit limits, prior authorization and annual caps vary by state and change how much a single code is worth to a practice.
Timing matters too. 10 states set the current rate for 90901 in 2026 or later, while 5 states still pay a rate that took effect in 2022 or earlier. A state that has not updated its rate in years will drift down the ranking as others raise theirs.
What managed-care plans pay for 90901
What a plan pays for 90901 is negotiated privately, but the state decides how much room there is to negotiate. Here is how the rules break down across the 17 states.
In 1 state, the published rate binds plans: a floor, a pass-through or a state-set rate. In 10 states, plans negotiate and the published rate is a benchmark or out-of-network default. In 1 state, the service is paid outside the plans or through a state-directed payment. The rule for the remaining 5 states is not classified yet.
- Plans negotiate; the published rate applies out of network (10 states). In-network rates can be above or below the published rate. The published rate is the benchmark both sides know, and the fallback if no contract is signed.
- Paid by the state, outside the plans (1 state). Bill the state's Medicaid program, not the plan, at the published rate. There is no plan contract to negotiate for this service.
- Plans must pay at least the published rate (1 state). The published rate is your floor. Negotiate up from it, and if a plan pays less, the contract provision is the basis for a payment dispute.
Plan-negotiated rates are never estimated here. To see the rule and its citation for a particular state, open that state's managed-care page, for example New Mexico managed care.
Units and billing for 90901
90901 is a CPT medicine code in the therapy (PT/OT/speech) line, billed mostly by physical, occupational and speech therapists and therapy practices. The medicine section runs from vaccines and psychiatry to dialysis, cardiology and therapy. Some of its codes are timed in 15-minute units, others are billed once per session or per test, so the unit matters more here than in most sections.
Many treatment codes are timed in 15-minute units, while evaluations and re-evaluations are billed once per session. Medicare applies a rule for counting timed minutes into units; Medicaid programs may follow it or set their own, so check the state's therapy manual.
Medicare's 2026 physician fee schedule pays $38.05–$46.86 for 90901 (non-facility), depending on the Medicare locality. That is a useful reference point, but Medicare and Medicaid can define the unit differently, so compare only where the units match.
Before billing, confirm the rate, unit and any modifier with the state's current schedule or the plan: the amounts here are as published, not a guarantee of payment.
Frequently asked questions
What does Medicaid pay for 90901?
It depends on the state. Of the 17 states with a published fee-for-service rate, the median is $31.90. New Mexico pays the most ($105.32 per visit) and Kansas the least ($8.25).
Which state pays the highest Medicaid rate for 90901?
New Mexico, at $105.32 per visit, effective 2026-07-01.
Which state pays the lowest Medicaid rate for 90901?
Kansas, at $8.25, effective 2009-12-18. It publishes the code in a different unit from New Mexico, so compare per unit with care.
What unit is 90901 billed in?
Of the 17 states, 1 publish 90901 per visit, and 16 schedules print no unit at all (a flat amount per service).
How do Medicaid rates for 90901 compare with Medicare?
Where the billing units match, Medicaid pays 271% of the 2026 Medicare physician fee schedule amount for the state (non-facility).
Do managed-care plans pay the same rate for 90901?
Not necessarily. In 1 state, the published rate binds plans: a floor, a pass-through or a state-set rate. In 10 states, plans negotiate and the published rate is a benchmark or out-of-network default. In 1 state, the service is paid outside the plans or through a state-directed payment. The rule for the remaining 5 states is not classified yet. Each rule is cited to the plan contract, statute or notice in the workspace.