97161 Medicaid reimbursement rates by state
Physical therapy evaluation, level 1 of 3. 20 state Medicaid programs publish a fee-for-service rate for 97161 at the therapist pt level. Rates run from $10.27 in Illinois to $3,510.00 in New Jersey, with a median of $75.22.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 20
- Median rate
- $75.22units vary by state
- Highest
- $3,510.00New Jersey
- Medicare (non-facility)
- $91.50–$110.842026 physician fee schedule
97161 rate in every state
One like-for-like fee-for-service rate per state, highest first. Units can differ between states; the per-hour column converts time-based units.
| State | Medicaid rate | Unit | Per hour | Managed-care plans | % of Medicare | Source |
|---|---|---|---|---|---|---|
| New JerseyPhysical therapist · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $3,510.00⚠ over 3× mediansince 2025-12-01 | — | — | Not classified | — | NJMMIS Procedure Master Listing CPTHCPCS |
| TexasPhysician or licensed psychologist (incl. BCBA-D) · Texas Medicaid (fee-for-service, TMHP) | $116.19since 2017-09-01 | — | — | Plans negotiate; applies out of network | — | TMHP Texas Medicaid Fee Schedule - Physi |
| VirginiaPhysical therapist · Virginia Medicaid (fee-for-service, DMAS) | $105.84since 2026-07-01 | an evaluation | — | Plans negotiate; applies out of network | — | Outpatient Rehab Fee Schedule |
| ArizonaPhysical therapist · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $102.33since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | AHCCCS Arizona Health Care Cost Containm |
| IndianaPhysical therapist · Indiana Medicaid (fee-for-service) | $93.69since 2026-01-01 | unit | — | Plans must pay at least this | — | IHCP Professional Fee Schedule (Last Upd |
| NebraskaPhysical therapist · Nebraska Medicaid (fee-for-service) | $87.74since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Nebraska Medicaid fee schedule 471-000-5 |
| MissouriPhysical therapist · Missouri MO HealthNet (fee-for-service) | $85.88since 2022-07-01 | — | — | Paid by the state, outside plans | — | MO HealthNet fee schedule: First Steps |
| ColoradoPhysical therapist · Child Health Plan Plus (CHP+, Colorado's CHIP) | $83.86since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Child Health Plan Plus FY 2026-2027 Fee |
| MassachusettsPhysical therapist · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations) | $76.54since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | Emergency Adoption (date filed: Septembe |
| MinnesotaPhysical therapist · Minnesota Health Care Programs: Medical Assistance (fee-for-service) | $76.16since 2026-02-01 | — | — | Plans negotiate; applies out of network | — | MHCP Fee Schedule - Current Fee Schedule |
| GeorgiaPhysical therapist · Georgia New Options Waiver (NOW) for people with IDD | $74.27since 2024-04-01 | — | — | Paid by the state, outside plans | — | New Options Waiver Program 4.1.24 (archi |
| MarylandPhysical therapist · Maryland Medicaid (fee-for-service, MDH) | $70.69since 2026-01-01 | — | — | Not classified | — | Maryland Medicaid Professional Services |
| North CarolinaPhysical therapist · North Carolina Medicaid Direct (fee-for-service) | $66.11since 2025-10-01 | — | — | Plans must pay at least this | — | NC Medicaid fee schedule 'Nurse Midwives |
| PennsylvaniaPhysical therapist · Pennsylvania Medical Assistance (fee-for-service) | $63.61since 2021-09-01 | — | — | Plans negotiate; applies out of network | — | PA DHS PROMISe Outpatient Fee Schedule ( |
| OhioPhysical therapist · Ohio Medicaid School Program (school-based services) | $63.15since 2020-06-12 | — | — | Paid by the state, outside plans | — | Appendix DD to OAC 5160-1-60 (Non-Instit |
| WisconsinPhysical therapist · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $62.66since 2017-01-01 | — | — | Plans negotiate; applies out of network | — | ForwardHealth max fee schedule: Therapy- |
| MichiganPhysical therapist · Michigan Medicaid (fee-for-service) | $62.41since 2026-01-01 | — | — | Plans negotiate; applies out of network | — | MDHHS Physical Therapy Fee Schedule data |
| WashingtonPhysical therapist · Washington Apple Health (Medicaid) fee-for-service | $59.43since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | HCA Habilitative services fee schedule ( |
| FloridaPhysical therapist · Florida iBudget waiver for people with developmental disabilities (APD) | $54.38since 2026-07-01 | visit | — | Paid by the state, outside plans | — | Florida Medicaid Developmental Disabilit |
| IllinoisPhysical therapist · Illinois Medicaid (HFS fee-for-service) | $10.27since 2024-12-01 | — | — | Plans negotiate; applies out of network | — | HFS Therapy Fee Schedule (effective 2024 |
Rates marked ⚠ are more than three times the median for the same unit; they are published as shown but often reflect an office (non-facility) fee or a different scope of service. Rates are per the unit shown for each state; units can differ between states. Medicare amounts are computed from the CMS relative value file and locality cost indices with the CMS formula; states with several Medicare localities show a range. Confirm rates with the payer before billing.
Frequently asked questions
What does Medicaid pay for 97161?
It depends on the state. Of the 20 states with a published fee-for-service rate, the median is $75.22. New Jersey pays the most ($3,510.00) and Illinois the least ($10.27).
Which state pays the highest Medicaid rate for 97161?
New Jersey, at $3,510.00, effective 2025-12-01.
Do managed-care plans pay the same rate for 97161?
Not necessarily. Each state's plan contracts decide whether plans must pay at least the fee-for-service rate, pay a state-set rate, or negotiate their own. The table shows the rule for each state, cited to the contract or statute.